Prazeres Tatiana M B, Muller Rodrigo T, Rayes Tatiana, Hirai Flávio E, de Sousa Luciene B
*Department of Ophthalmology, Federal University of São Paulo, Sao Paulo, Brazil; and †Department of Ophthalmology, Sorocaba Eye Hospital, Sorocaba, Brazil.
Cornea. 2015 Jul;34(7):797-801. doi: 10.1097/ICO.0000000000000444.
To compare the visual outcomes of Descemet membrane (DM)-on and DM-off after deep anterior lamellar keratoplasty (DALK) using the big-bubble (BB) technique in keratoconus patients.
In this prospective trial, keratoconic eyes undergoing DALK procedures with the BB technique were randomized into 2 groups: a donor cornea without DM (group 1; 29 eyes) or with DM (group 2; 30 eyes). These groups were compared with respect to best-corrected visual acuity and contrast sensitivity while wearing gas permeable contact lenses and also endothelial cell counts.
There were no statistically significant differences between the 2 groups with regard to best-corrected visual acuity and contrast sensitivity using gas permeable contact lenses as well as endothelial cell counts at 3, 6, and 12 months. After 1 year, the mean (±SD) postoperative visual acuity CL (with contact lenses) was 0.05 (±0.01) in the DM-off group and 0.05 (±0.01) in the DM-on group (P = 0.956). Mean postoperative endothelial cell counts were 2425.0 (±123.7) and 2306.7 (79.9), respectively (P = 0.443), and corneal thicknesses were 527.9 (58.3) and 556.6 (47.3), respectively (P = 0.150). During the follow-up period, very few complications occurred and neither group had a predominance of adverse events at 3, 6, 12, or 24 months.
In conclusion, DALK procedures using the BB technique for keratoconus with DM-on or DM-off presented no significant differences regarding the visual outcomes or endothelial cell counts.
比较圆锥角膜患者采用大泡（BB）技术行深前板层角膜移植术（DALK）后保留后弹力层（DM）与去除DM的视觉效果。
在这项前瞻性试验中，采用BB技术行DALK手术的圆锥角膜眼被随机分为2组：供体角膜无DM组（第1组；29只眼）和有DM组（第2组；30只眼）。比较两组在佩戴透气硬性角膜接触镜时的最佳矫正视力、对比敏感度以及内皮细胞计数。
两组在佩戴透气硬性角膜接触镜时的最佳矫正视力、对比敏感度以及3、6和12个月时的内皮细胞计数方面无统计学显著差异。1年后，去除DM组术后平均（±标准差）视力（佩戴角膜接触镜）为0.05（±0.01），保留DM组为0.05（±0.01）（P = 0.956）。术后平均内皮细胞计数分别为2425.0（±123.7）和2306.7（79.9）（P = 0.443），角膜厚度分别为527.9（58.3）和556.6（47.3）（P = 0.150）。随访期间，并发症极少发生，两组在3、6、12或24个月时均无不良事件优势。
总之，圆锥角膜采用BB技术行DALK手术时，保留或去除DM在视觉效果或内皮细胞计数方面无显著差异。
