Romano Vito, Iovieno Alfonso, Parente Gabriella, Soldani Anna Maria, Fontana Luigi
Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy.
Eye Unit, Arcispedale Santa Maria Nuova - Istituto di Ricovero e Cura a Carattere Scientifico (ASMN-IRCCS), Reggio Emilia, Italy.
Am J Ophthalmol. 2015 Mar;159(3):505-11. doi: 10.1016/j.ajo.2014.11.033. Epub 2014 Dec 6.
To report long-term clinical outcomes of deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.
Retrospective noncomparative interventional study.
setting: Single center. patients: Total of 158 eyes/150 consecutive patients with keratoconus with postoperative follow-up time equal to or greater than 4 years. intervention: DALK. main outcome measure(s): Uncorrected and corrected distance visual acuity (UDVA, CDVA), mean refractive spherical equivalent (MRSE), keratometry, endothelial cell density (ECD).
Mean postoperative follow-up was 76.9 ± 23.2 (range 48-120) months. Preoperative UDVA was 20/400 (1.5 ± 0.4 logMAR), CDVA 20/50 (0.7 ± 0.2 logMAR), MRSE -11.1 ± 5.6 diopters (D), mean keratometry 60.7 ± 6.1 D, topographic astigmatism 4.7 ± 2.6 D. At last postoperative follow-up visit, UDVA improved to 20/50 (0.5 ± 0.3 logMAR), CDVA to 20/25 (0.09 ± 0.1 logMAR), MRSE to -2.6 ± 3.5 D, mean keratometry to 44.4 ± 2.2 D, and topographic astigmatism to 2.9 ± 1.3 D. Postoperative ECD did not vary from preoperative values being 2070.5 ± 367.5 cell/mm(2) and 2198 ± 373 cell/mm(2), respectively, with 70% of eyes (111/158) showing ECD ≥2000 cells/mm(2). Eighteen eyes (11.3 %) developed stromal or epithelial rejection, 3 (1.8%) required regrafting. Eyes with successful big bubble showed greater CDVA than those that required manual dissection at follow-up equal to or less than 5 years but comparable results in the longer term.
DALK provides stable long-term visual and refractive outcomes. Risk of graft rejection, postoperative complication, and late ECD decay is reduced when compared to standard penetrating keratoplasty.
报告圆锥角膜患者接受深前板层角膜移植术（DALK）的长期临床结果。
回顾性非对照干预性研究。
地点：单中心。患者：共158只眼/150例连续的圆锥角膜患者，术后随访时间等于或大于4年。干预措施：DALK。主要观察指标：未矫正和矫正远视力（UDVA、CDVA）、平均等效球镜度（MRSE）、角膜曲率、内皮细胞密度（ECD）。
术后平均随访时间为76.9±23.2（范围48 - 120）个月。术前UDVA为20/400（1.5±0.4 logMAR），CDVA为20/50（0.7±0.2 logMAR），MRSE为-11.1±5.6屈光度（D），平均角膜曲率为60.7±6.1 D，地形图散光为4.7±2.6 D。在术后最后一次随访时，UDVA提高到20/50（0.5±0.3 logMAR），CDVA提高到20/25（0.09±0.1 logMAR），MRSE提高到-2.6±3.5 D，平均角膜曲率提高到44.4±2.2 D，地形图散光提高到2.9±1.3 D。术后ECD与术前值无差异，分别为2070.5±367.5个细胞/mm²和2198±373个细胞/mm²，70%的眼（111/158）ECD≥2000个细胞/mm²。18只眼（11.3%）发生基质或上皮排斥反应，3只眼（1.8%）需要再次移植。在随访时间等于或小于5年时，成功形成大泡的眼比需要手动分离的眼CDVA更高，但长期结果相当。
DALK可提供稳定的长期视力和屈光结果。与标准穿透性角膜移植相比，移植排斥反应、术后并发症和晚期ECD下降的风险降低。
