Schaub Friederike, Enders Philip, Bachmann Björn O, Heindl Ludwig M, Cursiefen Claus
Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
Graefes Arch Clin Exp Ophthalmol. 2017 Apr;255(4):811-816. doi: 10.1007/s00417-017-3592-2. Epub 2017 Jan 30.
The purpose was to investigate the impact of ultraviolet light corneal collagen crosslinking (UV-CXL) on the success rate and clinical outcome of subsequent deep anterior lamellar keratoplasty (DALK) in eyes with keratoconus (KC).
Medical records of 101 consecutive eyes with KC scheduled for big-bubble DALK surgery were screened retrospectively for details of previously performed UV-CXL, as well as intra- and postoperative complications of DALK surgery. Main outcome measures were intraoperative success rates (big-bubble formation, conversion to penetrating keratoplasty (PK)), postoperative complications, best corrected visual acuity (BCVA), endothelial cell density (ECD), and central corneal thickness (CCT) within 18 months of follow-up.
Out of the 101 KC eyes, eight eyes (7.9%) had a history of previous UV-CXL. Surgical failure, defined as conversion to PK due to macroperforation, occurred in 17 eyes (16.8%) of 93 eyes without and in none with previous UV-CXL (P < .001). Failure to achieve a big-bubble occurred in 37 eyes (40.2%) without previous UV-CXL and in two eyes (25%) with previous UV-CXL. Microperforations of Descemet's membrane were observed in ten eyes (20.7%) without and in 14 eyes (15.2%) with previous UV-CXL (P = .16). No significant differences could be detected for either the postoperative complication rate (P ≥ .18) or the clinical outcome parameters at 18 months follow-up, including BCVA, ECD and CCT (P ≥ .08) for eyes with or without UV-CXL.
In DALK surgery, prior UV-CXL does not seem to affect the rate of intra- or postoperative complications, the success rate, or its clinical outcome.
本研究旨在探讨紫外线角膜胶原交联术（UV-CXL）对圆锥角膜（KC）患者后续深板层角膜移植术（DALK）成功率和临床结局的影响。
回顾性筛查101例计划行大泡法DALK手术的连续KC患者的病历，了解先前UV-CXL的详细情况以及DALK手术的术中及术后并发症。主要观察指标包括术中成功率（大泡形成、转为穿透性角膜移植术（PK））、术后并发症、最佳矫正视力（BCVA）、内皮细胞密度（ECD）以及随访18个月内的中央角膜厚度（CCT）。
101例KC患者中，8例（7.9%）有先前UV-CXL史。手术失败定义为因大穿孔转为PK，在93例无先前UV-CXL的患者中有17例（16.8%）发生，而有先前UV-CXL的患者中无1例发生（P＜0.001）。未行先前UV-CXL的患者中有37例（40.2%）未形成大泡，有先前UV-CXL的患者中有2例（25%）未形成大泡。未行先前UV-CXL的患者中有10例（20.7%）观察到后弹力层微穿孔，有先前UV-CXL的患者中有14例（15.2%）观察到后弹力层微穿孔（P = 0.16）。对于有无UV-CXL的患者，术后并发症发生率（P≥0.18）或随访18个月时的临床结局参数，包括BCVA、ECD和CCT（P≥0.08）均未发现显著差异。
在DALK手术中，先前的UV-CXL似乎不影响术中或术后并发症发生率、成功率或临床结局。
