Ozmen Mehmet Cuneyt, Yesilirmak Nilufer, Aydin Bahri, Ceylanoglu Kubra Serbest, Atalay Hatice Tuba, Akata Fikret
Department of Cornea, Gazi University Hospital, Ankara, Turkey.
Eye Contact Lens. 2018 Nov;44 Suppl 2:S176-S179. doi: 10.1097/ICL.0000000000000434.
To report big-bubble deep anterior lamellar keratoplasty (DALK) in patients with keratoconus with corneal stromal scar, and to investigate factors that can influence intraoperative Descemet membrane (DM) perforation.
A retrospective study included patients with keratoconus with central stromal scar that underwent DALK using the big-bubble technique. Best spectacle-corrected visual acuity (BSCVA), keratometry, minimum corneal thickness (MCT), stromal scar depth, and endothelial cell density (ECD) were recorded. Receiver operating characteristic (ROC) curves were analyzed to predict an intraoperative perforation related to stromal scar.
Thirty-eight eyes of 38 patients with keratoconus (mean age: 30.0±9.2 years) were included in this study. Thirty-four eyes had successful DALK; in four eyes, the procedure was converted to penetrating keratoplasty because of DM macroperforations. Successful big-bubble formation was achieved in 24 of 38 (63.2%) eyes, whereas in 10 eyes, manual dissection was used to complete the DALK. Mean preoperative and postoperative second year BSCVA were 1.3 (±0.4) and 0.5 (±0.2) logarithm of the minimum angle of resolution (P<0.001), keratometry values were 65.5±7.4 and 42.8±7.8 diopters (P<0.001), and ECD were 2,740±359 and 2,279±452 cells/mm (P<0.001), respectively. Using ROC analysis, the area under curve value to predict DM perforation was found to be 0.792 (scar/MCT ratio, P=0.04) and the best cutoff point for scar depth/MCT ratio was 53%.
Big-bubble DALK is effective in patients with keratoconus with stromal scars. Scar depth/MCT ratio seems to predict the DM perforation.
报告对伴有角膜基质瘢痕的圆锥角膜患者行大泡深板层角膜移植术（DALK）的情况，并探讨影响术中后弹力层（DM）穿孔的因素。
一项回顾性研究纳入了采用大泡技术对伴有中央基质瘢痕的圆锥角膜患者行DALK的病例。记录最佳矫正视力（BSCVA）、角膜曲率、最小角膜厚度（MCT）、基质瘢痕深度和内皮细胞密度（ECD）。分析受试者工作特征（ROC）曲线以预测与基质瘢痕相关的术中穿孔情况。
本研究纳入了38例圆锥角膜患者的38只眼（平均年龄：30.0±9.2岁）。34只眼DALK手术成功；4只眼因DM大穿孔而改为穿透性角膜移植术。38只眼中24只（63.2%）成功形成大泡，而10只眼采用手动剥离完成DALK。术前和术后第二年的平均BSCVA分别为1.3（±0.4）和0.5（±0.2）最小分辨角对数（P<0.001），角膜曲率值分别为65.5±7.4和42.8±7.8屈光度（P<0.001），ECD分别为2740±359和2279±452个细胞/mm²（P<0.001）。采用ROC分析，预测DM穿孔的曲线下面积值为0.792（瘢痕/MCT比值，P=0.04），瘢痕深度/MCT比值的最佳截断点为53%。
大泡DALK对伴有基质瘢痕的圆锥角膜患者有效。瘢痕深度/MCT比值似乎可预测DM穿孔。
