Department of Ophthalmology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.
J Zhejiang Univ Sci B. 2013 May;14(5):438-50. doi: 10.1631/jzus.B1200272.
To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus.
Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups.
A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006).
Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.
比较全层深板层角膜移植术（DALK）与穿透性角膜移植术（PK）治疗圆锥角膜的术后效果。
本回顾性研究纳入了 2000 年 6 月至 2010 年 8 月期间接受全层 DALK 的 64 例 75 眼和接受 PK 的 51 例 52 眼患者。全层 DALK 采用姚氏钩分离技术，PK 采用标准技术。比较两组患者的术中及术后并发症、视力、排斥反应、移植物存活率、角膜内皮细胞密度、角膜知觉恢复和再神经支配情况。
全层 DALK 术后视力达到 0.5 或以上的比例为 90.7%，PK 术后为 92.3%（P=0.75）。术后第 5 年，PK 组的移植角膜内皮细胞丢失率为 34.6%，全层 DALK 组为 13.9%（P<0.001）。两组患者的角膜知觉恢复或再神经支配情况无统计学差异（P>0.05）。全层 DALK 组有 7 眼（9.3%）术中发生微小穿孔，其中 2 眼术后出现暂时性前房加深。PK 组与全层 DALK 组术后并发症分别为：排斥反应（7.7%比 0%，P=0.015）、高眼压（46.2%比 1.3%，P<0.001）、继发性青光眼（9.6%比 0%，P=0.006）、并发性白内障（19.2%比 0%，P<0.001）和伤口裂开（9.6%比 0%，P=0.006）。
全层 DALK 和 PK 均可为圆锥角膜患者提供长期满意的视力结果。仅在 PK 术后观察到移植物排斥反应、继发性青光眼、并发性白内障和持续的内皮细胞丢失。
