Department of Corneal and External Eye Diseases, Moorfields Eye Hospital, London, United Kingdom.
Department of Corneal and External Eye Diseases, Moorfields Eye Hospital, London, United Kingdom.
Am J Ophthalmol. 2019 May;201:54-62. doi: 10.1016/j.ajo.2019.01.022. Epub 2019 Feb 2.
To examine clinical outcomes in deep anterior lamellar keratoplasty (DALK) for keratoconus using contemporary techniques in a multisurgeon public healthcare setting.
Consecutive, retrospective case series.
Setting: Moorfields Eye Hospital, London, United Kingdom.
Consecutive cases of keratoconus treated with non-laser assisted DALK from September 1, 2012, to September 31, 2016.
Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived for analysis.
Graft failure rate and percentage of patients with corrected distance visual acuity (CDVA) ≥20/40 within 1 year of surgery and at final review after suture removal.
Three hundred fifty-seven eyes of 338 patients undergoing DALK (91.3% big-bubble technique attempted) were analyzed. A total of 4.2% (95% confidence interval [CI] 2.4%-6.8%) of corneal transplants had failed within the follow-up period (21.8 ± 11.4 months), and 75.9% of eyes had CDVA ≥20/40 within 1 year of surgery, rising to 81% after suture removal. Forty-two primary surgeons (31 trainees) participated. Intraoperative perforation of Descemet membrane occurred in 45.4% of eyes. A total of 24.1% were converted to penetrating keratoplasty (PK) intraoperatively. Conversion to PK increased the risk of transplant rejection (P = .026; odds ratio [OR] 1.94; 95% CI 1.1-3.5) and secondary glaucoma (P = .016; OR 4.0; 95% CI 1.3-12.4). Transplant rejection increased the risk of graft failure both overall (P = .017; OR = 3.9; 95% CI 1.4-11.0) and when cases converted to PK were excluded (P = .028; OR = 3.35; 95% CI 1.1-9.9).
DALK for keratoconus achieves early results similar to those published for PK in a multisurgeon setting. Conservative management of intraoperative Descemet membrane perforation, where possible, may be safer than conversion to PK.
在多外科医生的公共医疗保健环境中，使用现代技术检查深层前板层角膜移植术（DALK）治疗圆锥角膜的临床结果。
连续回顾性病例系列。
地点：伦敦莫尔菲尔德眼科医院。
2012 年 9 月 1 日至 2016 年 9 月 31 日，连续接受非激光辅助 DALK 治疗的圆锥角膜患者。
归档了术前状态、手术细节、术中及术后并发症、二次干预以及视力结果的数据以进行分析。
手术后 1 年和缝线拆除后最终随访时的移植物失败率以及矫正视力（CDVA）≥20/40 的患者比例。
分析了 338 名患者的 357 只眼（91.3%尝试大泡技术）的 DALK 结果。在随访期间（21.8±11.4 个月），角膜移植物有 4.2%（95%置信区间[CI]2.4%-6.8%）失败，75.9%的患者术后 1 年的 CDVA≥20/40，缝线拆除后上升至 81%。42 名主要外科医生（31 名受训者）参与了手术。术中发生 45.4%的后弹力层膜穿孔。共有 24.1%的患者术中改行穿透性角膜移植术（PK）。改行 PK 会增加移植物排斥的风险（P=.026；比值比[OR]1.94；95%CI 1.1-3.5）和继发性青光眼（P=.016；OR 4.0；95%CI 1.3-12.4）。总体上（P=.017；OR=3.9；95%CI 1.4-11.0）和排除改行 PK 的病例时（P=.028；OR=3.35；95%CI 1.1-9.9），移植物排斥会增加移植物失败的风险。
多外科医生环境中，DALK 治疗圆锥角膜的早期结果与 PK 发表的结果相似。术中尽可能保守处理后弹力层膜穿孔可能比改行 PK 更安全。
