Ophthalmic Research Center and Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Cornea. 2010 Nov;29(11):1252-5. doi: 10.1097/ICO.0b013e3181d83710.
To compare visual acuity and refractive outcomes after Anwar's deep anterior lamellar keratoplasty (DALK) between eyes with and without successful big-bubble formation.
In this retrospective comparative study, keratoconic eyes undergoing DALK with the big-bubble technique were divided into 2 groups: group 1 in which a bared Descemet membrane (DM) was achieved and group 2 in which layer-by-layer manual dissection was performed because of the lack of big-bubble formation after several intrastromal air injections. The 2 groups were compared with respect to best spectacle-corrected visual acuity, keratometric astigmatism, and refractive error at months 1, 3, 6, and 12, and at least 3 months after complete suture removal.
A total of 123 keratoconic eyes were enrolled. A bared DM was successfully achieved in 100 eyes (81.3%) (group 1), whereas in 23 eyes (18.7%) (group 2), some posterior stroma was left in place. The mean follow-up period was 21 ± 9 months in group 1 and 23 ± 9 months in group 2 (P = 0.37). Postoperative best spectacle-corrected visual acuity was significantly better in group 1 than in group 2 at months 1, 3, 6, and 12. But, at the final examinations, there was no significant difference between the study groups (0.24 ± 0.21 logarithm of the minimum angle of resolution in group 1 and 0.32 ± 0.14 logarithm of the minimum angle of resolution in group 2; P = 0.18). The 2 groups were comparable regarding keratometric astigmatism and spherical equivalent refractive error throughout the follow-up period.
Retention of posterior corneal stroma delayed visual recovery after DALK using Anwar's technique, but the participants in this group ultimately reached the same levels of visual acuity as observed in the bared-DM group.
比较 Anwar 深板层角膜移植术（DALK）后有和无成功大泡形成的角膜混浊眼的视力和屈光结果。
在这项回顾性比较研究中，行大泡技术 DALK 的圆锥角膜眼分为两组：组 1 中，成功暴露了后弹力层（Descemet 膜，DM）；组 2 中，由于多次间质内注气后仍未形成大泡，因此进行了逐层手动分离。两组在术后 1、3、6 和 12 个月以及完全拆线后至少 3 个月时，比较最佳矫正视力、角膜散光和屈光误差。
共纳入 123 只圆锥角膜眼。100 只眼（81.3%）（组 1）成功暴露 DM，23 只眼（18.7%）（组 2）仍有部分后弹力层保留。组 1 和组 2 的平均随访时间分别为 21 ± 9 个月和 23 ± 9 个月（P = 0.37）。术后 1、3、6 和 12 个月，组 1 的最佳矫正视力明显优于组 2，但在最终检查时，两组间无显著差异（组 1 为 0.24 ± 0.21 对数最小分辨角视力，组 2 为 0.32 ± 0.14 对数最小分辨角视力；P = 0.18）。整个随访期间，两组的角膜散光和等效球镜屈光误差无显著差异。
保留部分后弹力层会延迟 Anwar 技术行 DALK 后的视力恢复，但该组患者最终达到了与暴露 DM 组相同的视力水平。
