Department of Ophthalmology (N.S., T.Y., D.T., K.T., J.S.), Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan; and Department of Ophthalmology (N.S., T.Y., K.T., J.S.), Keio University School of Medicine, Tokyo, Japan.
Eye Contact Lens. 2019 Jul;45(4):238-245. doi: 10.1097/ICL.0000000000000561.
To evaluate the incidence of the Descemet membrane (DM) folds after deep anterior lamellar keratoplasty (DALK) in treating keratoconus. We also evaluated the influence of DM folds and corneal higher-order aberrations (HOAs) on visual acuity after DALK.
This retrospective study included 89 consecutive eyes of 87 patients who underwent DALK for the treatment of keratoconus at Tokyo Dental College Ichikawa General Hospital from April 2002 to June 2017. The presence or absence of DM folds was determined by slitlamp microscopy. Visual acuity after DALK was compared between the eyes with and without DM folds. Corneal HOAs of the anterior and posterior surfaces and the total cornea were measured by anterior segment optical coherence tomography. Correlations among the presence of DM folds, corneal HOAs, and visual acuity were analyzed.
The Descemet membrane folds developed in 28.1% (25/89) eyes after DALK for the treatment of keratoconus. However, there were no significant differences in postoperative visual acuity between the eyes with and without DM folds at 1, 3, 6, and 12 months (P=0.739, P=0.106, P=0.223, and P=0.186, respectively). The visual acuity at 12 months was significantly correlated with corneal HOAs within a 4-mm diameter (anterior surface: R=0.546, P=0.003; total cornea: R=0.506, P=0.007).
Larger corneal HOAs, but not the presence of DM folds, were associated with poor visual acuity after DALK. In treating advanced keratoconus with DALK, it is important to minimize postoperative corneal HOAs, although DALK improves visual acuity by reducing HOAs due to keratoconus.
评估深板层角膜移植术（DALK）治疗圆锥角膜后出现的后弹力层（Descemet 膜，DM）皱褶的发生率。我们还评估了 DM 皱褶和角膜高阶像差（HOAs）对 DALK 后视力的影响。
这是一项回顾性研究，纳入 2002 年 4 月至 2017 年 6 月期间在东京齿科大学市川综合医院因圆锥角膜接受 DALK 治疗的 87 例 89 只眼。通过裂隙灯显微镜确定是否存在 DM 皱褶。比较 DALK 术后存在和不存在 DM 皱褶的眼的视力。通过眼前节光学相干断层扫描测量前表面和后表面以及整个角膜的角膜 HOAs。分析 DM 皱褶的存在、角膜 HOAs 和视力之间的相关性。
28.1%（25/89）只接受 DALK 治疗的圆锥角膜眼术后出现 DM 皱褶。然而，在术后 1、3、6 和 12 个月时，存在和不存在 DM 皱褶的眼的术后视力无显著差异（P=0.739、P=0.106、P=0.223 和 P=0.186）。12 个月时的视力与 4mm 直径内的角膜 HOAs 显著相关（前表面：R=0.546，P=0.003；总角膜：R=0.506，P=0.007）。
较大的角膜 HOAs，而不是 DM 皱褶的存在，与 DALK 后视力差有关。在使用 DALK 治疗晚期圆锥角膜时，重要的是要尽量减少术后角膜 HOAs，尽管 DALK 通过减少圆锥角膜引起的 HOAs 来提高视力。
