State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Qingdao, China.
Ophthalmology. 2010 Feb;117(2):226-31. doi: 10.1016/j.ophtha.2009.07.005. Epub 2009 Dec 6.
To determine the clinical efficacy of modified deep lamellar keratoplasty for the treatment of advanced-stage keratoconus with steep curvature.
Retrospective, noncomparative clinical trial.
Fifty-nine keratoconus patients with a curvature of more than 60 diopters (D) in 65 eyes were studied. All affected eyes were in the advanced stage with typical clinical characteristics, and 31 of the eyes had midstromal scars in the central cornea.
All patients were treated with modified deep lamellar keratoplasty. Briefly, four-fifths thickness of the corneal lamellae was cut using a Hessburg-Barron vacuum trephine (with a diameter of 7.75 mm). The incisal edge of the cornea was drawn using toothed forceps, and the lamellae were cut with a diamond knife along the stromal fibers. At the top of the cone, 2 mm (in diameter) of Descemet's membrane was left. A corneal graft (8.0 mm in diameter) was sutured to the recipient using a gradual pressure technique to decrease the occurrence of folds in the central cornea. Complications during and after the surgery were recorded. The transparency of the graft, eye vision, and cornea curvature were monitored during follow-ups.
Surgical effect and visual acuity after modified deep lamellar keratoplasty in patients with keratoconus.
No corneal perforation occurred during the operations. Nine patients had mild liquid accumulation underneath the graft, but it disappeared 1 to 2 days after the surgery. The corneal graft attached to the patient's eye well, and there was no obvious fold in the center. The average best-corrected visual acuity was 20/32 between 3 months and 1 year after surgery and reached 20/25 at 1 year after the operation. There was no detectable corneal graft rejection during the follow-ups.
This modified deep lamellar keratoplasty procedure for the treatment of keratoconus in patients with advanced-stage disease and steep curvature seems to provide similar efficacy to penetrating keratoplasty and may decrease the risk of immune rejection when compared with historical outcomes.
探讨改良深层板层角膜移植术治疗大曲率高陡角膜圆锥的临床疗效。
回顾性非对照临床试验。
研究对象为 65 只患眼角膜曲率>60 屈光度（D）的圆锥角膜患者 59 例（65 只眼）。所有患眼均处于晚期，具有典型的临床特征，其中 31 只眼中央角膜基质有中重度混浊。
所有患者均行改良深层板层角膜移植术。简要过程如下：使用 Hessburg-Barron 真空环钻（直径 7.75mm）切取角膜瓣的 4/5 厚度，用有齿镊提起角膜瓣，用钻石刀沿基质纤维方向切割角膜瓣。在圆锥顶点上方保留 2mm（直径）的基质内 Descemet 膜。用逐渐加压技术将直径 8.0mm 的角膜移植物缝合到受体角膜上，以减少中央角膜褶皱的发生。记录手术中和手术后的并发症。随访过程中监测移植片的透明度、视力和角膜曲率。
圆锥角膜患者改良深层板层角膜移植术后的手术效果和视力。
手术过程中未发生角膜穿孔。9 例患者术后轻度角膜下积液，但术后 1~2d 自行吸收。角膜移植片与患者眼贴合良好，中央无明显褶皱。术后 3 个月至 1 年平均最佳矫正视力为 20/32，术后 1 年达到 20/25。随访过程中未发现角膜移植排斥反应。
改良深层板层角膜移植术治疗晚期大曲率高陡角膜圆锥的效果与穿透性角膜移植术相似，与历史结果相比，免疫排斥反应的风险可能降低。
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