Khattak Ashbala, Nakhli Fouad R, Al-Arfaj Khaled M, Cheema Abdullah A
Dhahran Eye Specialist Hospital, Dhahran, 31942-39455, Kingdom of Saudi Arabia.
Dammam University, Dammam, Kingdom of Saudi Arabia.
Int Ophthalmol. 2018 Jun;38(3):985-992. doi: 10.1007/s10792-017-0548-9. Epub 2017 May 22.
To compare visual acuity, refraction, topography, and complications of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) performed in patients with keratoconus (KCN).
In this retrospective interventional non-randomized clinical study, patients with moderate to severe KCN that underwent either PKP or DALK for optical corrections were enrolled. The final outcome analysis was performed after complete suture removal for both groups of patients. Best corrected visual acuity, spherical equivalent, refractive cylinder, average keratometry, corneal astigmatism, and endothelial cell density as well as early and late complications such as cataract, glaucoma, corneal edema, elevated intraocular pressure without visual field defect or optic disk changes, rejection, loose suture, and re-suturing were compared.
Two hundred and seven eyes were enrolled: 108 eyes underwent DALK, and 99 eyes underwent PKP for keratoconus. The mean follow-up time was 28.06 ± 12.62 months for DALK group and 29.29 ± 12.71 months for PKP. The study groups demonstrated comparable final outcome in terms of best corrected visual acuity: 0.25 ± 0.22 LogMAR and 0.28 ± 0.24 LogMAR (p = 0.415), spherical equivalent: -4.80 ± 4.55D and -3.58 ± 3.58D (p = 0.067), refractive cylinder: -3.37 ± 2.00D and -4.00 ± 2.15D (p = 0.061), average keratometry: 45.51 ± 2.30D and 44.85 ± 2.36D (p = 0.077), corneal astigmatism: 4.89 ± 3.07D and 4.63 ± 2.61D (p = 0.569) in DALK (n = 85) and PKP (n = 72), respectively. However, the postoperative endothelial cell density in DALK (n = 61) 2250 ± 450 cell/mm differs significantly from it in PKP (n = 55) 1795 ± 616 cell/mm p < 0.001. Eyes that had DALK (n = 99) had significantly more risk of loose suture (RR 5.2) and re-suturing (RR 3.6) than PKP (n = 108). However, the risk of cataract following DALKs was less than PKP (OR 0.4).
The vision, refractive error, and corneal astigmatism following DALK and PKP were comparable; however, DALK had lower incidence of long-term complications.
比较圆锥角膜（KCN）患者接受深板层角膜移植术（DALK）和穿透性角膜移植术（PKP）后的视力、屈光、角膜地形图及并发症情况。
在这项回顾性干预性非随机临床研究中，纳入了因光学矫正而接受PKP或DALK的中重度KCN患者。两组患者均在完全拆除缝线后进行最终结果分析。比较最佳矫正视力、等效球镜度、屈光柱镜度、平均角膜曲率、角膜散光和内皮细胞密度，以及白内障、青光眼、角膜水肿、无视野缺损或视盘改变的眼压升高、排斥反应、缝线松动和再次缝合等高、早期并发症。
共纳入207只眼：108只眼接受了DALK，99只眼接受了PKP治疗圆锥角膜。DALK组的平均随访时间为28.06±12.62个月，PKP组为29.29±12.71个月。研究组在最佳矫正视力方面显示出可比的最终结果：DALK组（n = 85）为0.25±0.22 LogMAR，PKP组（n = 72）为0.28±0.24 LogMAR（p = 0.415）；等效球镜度：-4.80±4.55D和-3.58±3.58D（p = 0.067）；屈光柱镜度：-3.37±2.00D和-4.00±2.15D（p = 0.061）；平均角膜曲率：45.51±2.30D和44.85±2.36D（p = 0.077）；角膜散光：4.89±3.0D和4.63±2.61D（p = 0.569）。然而，DALK组（n = 61）术后内皮细胞密度为2250±450个细胞/mm²，与PKP组（n = 55）的1795±616个细胞/mm²有显著差异，p < 0.001。接受DALK的眼（n = 99）比PKP（n = 108）有更高的缝线松动风险（RR 5.2）和再次缝合风险（RR 3.6）。然而，DALK后白内障的风险低于PKP（OR 0.4）。
DALK和PKP后的视力、屈光不正和角膜散光相当；然而DALK的长期并发症发生率较低。
