Tennent Institute of Ophthalmology, Gartnavel General Hospital, Great Western Road, Glasgow G12 0YN, UK.
Br J Ophthalmol. 2012 Sep;96(9):1200-3. doi: 10.1136/bjophthalmol-2012-301947. Epub 2012 Jul 23.
To report long term visual outcomes, complications and graft survival of patients undergoing deep anterior lamellar keratoplasty (DALK) to treat corneal scarring secondary to herpes simplex virus (HSV) keratitis.
Retrospective, non-comparative case series. 18 patients who underwent DALK for HSV keratitis related corneal scarring between January 2004 and February 2007 were included. DALK was performed by Anwar's big bubble technique. Data collected for analysis included preoperative characteristics, intraoperative complications and postoperative acuity, complications and subsequent operations.
Mean best corrected distance visual acuity (LogMAR) improved from 1.51 ± 0.90 preoperatively to 0.82 ± 0.85 at the last follow-up (p=0.05). 27% of patients with more than 4 years follow-up had a best corrected distance visual acuity of 6/12 or better and 64% were 6/24 or better. Six patients (33%) experienced a recurrence of HSV keratitis and 9 (50%) experienced an episode of graft rejection. There were five cases (28%) of graft failure, four of whom had had a previous episode of graft rejection. Logistic regression did not find an association with graft rejection, HSV recurrence, any other observed postoperative host corneal vascularisation and any postoperative complication. The majority of patients underwent a second operation with 50% requiring cataract surgery.
DALK for the treatment of HSV related corneal scarring is associated with a high percentage of postoperative complications. DALK in this context is also associated with a large percentage of secondary operations. Patients should be aware of this when giving informed consent for DALK to treat HSV related corneal scars.
报告行深板层角膜移植术（DALK）治疗单纯疱疹病毒（HSV）角膜炎相关角膜瘢痕患者的长期视力结果、并发症和移植物存活率。
回顾性、非对照病例系列研究。纳入 2004 年 1 月至 2007 年 2 月期间因 HSV 角膜炎相关性角膜瘢痕而行 DALK 的 18 例患者。采用 Anwar 的大泡技术行 DALK。收集分析的资料包括术前特征、术中并发症和术后视力、并发症及后续手术情况。
平均最佳矫正远视力（LogMAR）从术前的 1.51±0.90 提高至末次随访时的 0.82±0.85（p=0.05）。随访时间超过 4 年的患者中，27%的最佳矫正远视力达到 6/12 或以上，64%的患者达到 6/24 或以上。6 例（33%）患者出现 HSV 角膜炎复发，9 例（50%）患者出现移植物排斥反应。有 5 例（28%）移植物失败，其中 4 例既往有移植物排斥反应。Logistic 回归未发现移植物排斥反应、HSV 复发、术后任何观察到的宿主角膜血管化和任何术后并发症之间存在关联。大多数患者行二次手术，其中 50%需要行白内障手术。
行 DALK 治疗 HSV 相关角膜瘢痕与较高的术后并发症发生率相关。在这种情况下，DALK 也与较大比例的二次手术相关。患者在知情同意行 DALK 治疗 HSV 相关角膜瘢痕时应了解这一点。
