Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University, Boostan 9 St., Pasdaran Avenue, Tehran, Iran.
Cornea. 2010 Apr;29(4):365-71. doi: 10.1097/ICO.0b013e3181b81b71.
To compare deep anterior lamellar keratoplasty (DALK) using the big-bubble technique to penetrating keratoplasty (PK) in patients with keratoconus.
In this clinical trial, patients with moderate to advanced keratoconus with poor spectacle-corrected visual acuity and intolerant to contact lens wear were enrolled. DALK was performed using the big-bubble technique, and a full-thickness donor cornea without Descemet membrane was sutured to the recipient bed. PK was performed conventionally with a Hessburg-Barron suction trephine. Three types of suturing were used for both groups. Postoperative refractive errors, best-corrected visual acuity (BCVA), contrast sensitivity function (CSF), and higher order aberrations (HOAs) were compared between the study groups.
The study included 81 eyes of 81 patients. Forty-six eyes underwent DALK from which 4 were excluded because of failure to achieve bared Descemet membrane. Thirty-five eyes received PK. Mean patient age was 26.91 ± 7.9 versus 30.89 ± 10.3 years in the DALK and PK groups, respectively (P = 0.06). Mean follow-up period was 22.0 ± 7.9 months in the DALK group and 24.6 ± 3.5 months in the PK group (P = 0.32). Mean postoperative spherical equivalent refractive error was -3.23 ± 3.4 diopters in the DALK group versus -2.22 ± 4.6 diopters in the PK group (P = 0.28), and mean postoperative BCVA was 0.18 ± 0.08 and 0.15 ± 0.10 logarithm of the minimum angle of resolution, respectively (P = 0.12). CSF and total aberrations and HOAs were comparable in the study groups.
DALK is an effective alternative surgical procedure for patients with keratoconus; the outcomes are comparable to PK in terms of refractive errors, BCVA, CSF, and HOAs.
比较角膜深层板层切除术（DALK）联合大泡技术与穿透性角膜移植术（PK）治疗圆锥角膜的效果。
本临床试验纳入了中重度圆锥角膜、且无法通过眼镜矫正视力或不能耐受角膜接触镜的患者。DALK 采用大泡技术，将无内皮层的全厚供体角膜缝合于受床。PK 采用 Hessburg-Barron 环钻进行常规手术。两组均采用 3 种缝线方法。比较两组术后的屈光不正、最佳矫正视力（BCVA）、对比敏感度功能（CSF）和高阶像差（HOAs）。
该研究共纳入 81 例 81 只眼患者。其中 46 只眼行 DALK 治疗，4 只眼因未能暴露内皮层而被排除。35 只眼行 PK 治疗。DALK 组和 PK 组患者的平均年龄分别为 26.91 ± 7.9 岁和 30.89 ± 10.3 岁（P = 0.06）。DALK 组和 PK 组的平均随访时间分别为 22.0 ± 7.9 个月和 24.6 ± 3.5 个月（P = 0.32）。DALK 组术后平均等效球镜屈光度为-3.23 ± 3.4 屈光度，PK 组为-2.22 ± 4.6 屈光度（P = 0.28），DALK 组和 PK 组术后平均 BCVA 分别为 0.18 ± 0.08 和 0.15 ± 0.10 最小分辨角对数视力（logMAR）（P = 0.12）。两组的 CSF 和总像差及 HOAs 无显著差异。
DALK 是治疗圆锥角膜的有效手术方法，在屈光不正、BCVA、CSF 和 HOAs 等方面与 PK 具有相似的效果。
