圆锥角膜患者深板层角膜移植术后出现 Descemet 膜皱褶的临床特征及危险因素。

Clinical Properties and Risk Factors for Descemet Membrane Folds After Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus.

机构信息

Department of Ophthalmology and Visual Science, Shanghai Medical College, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.

Key Laboratory of Myopia of State Health Ministry and Key Laboratory of Visual Impairment and Restoration of Shanghai, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.

出版信息

Cornea. 2019 Oct;38(10):1222-1227. doi: 10.1097/ICO.0000000000002075.

DOI:10.1097/ICO.0000000000002075

PMID:31369462

Abstract

PURPOSE

To report the clinical properties and risk factors for corneal Descemet membrane (DM) folds after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.

METHODS

This is a retrospective case-control study. Study participants-experimental group: 44 eyes with DM folds after DALK; control group: 135 eyes without DM folds after DALK.

RESULTS

Forty eyes with DM folds were displayed as 1 or 2 translucent lines in the DM layer. Three eyes appeared as several arcuate shape lines, and 1 eye presented as a radial shape. DM folds impaired corrected visual acuity after DALK (P = 0.018). Age older than 20.5 years at surgery and disease duration longer than 5.5 years were independent risk factors for DM fold formation after DALK surgery (odds ratio 5.39, 95% confidence interval: 2.11-13.73, P < 0.001; 6.60, 95% confidence interval: 2.92-14.94, P < 0.001). Preoperative Kmean, Kmax, central corneal thickness, anterior chamber depth, sex, history of rigid gas permeable contact lens wearing, Vogt striae, stromal scar, and intraoperative microperforation had no influence on the occurrence of DM folds (P1 = 0.775, P2 = 0.896, P3 = 0.555, P4 = 0.182, P5 = 0.656, P6 = 0.237, P7 = 1.000, P8 = 0.587, and P9 = 0.798).

CONCLUSIONS

DM folds impaired postoperative corrected visual acuity. The risk factors for DM folds included age older than 20.5 years and disease duration longer than 5.5 years.

摘要

目的

报告圆锥角膜患者行深板层角膜移植术后（DALK）角膜后弹力层（Descemet 膜，DM）皱褶的临床特征和危险因素。

方法

这是一项回顾性病例对照研究。研究对象-实验组：44 只行 DALK 术后发生 DM 皱褶的眼；对照组：135 只行 DALK 术后未发生 DM 皱褶的眼。

结果

40 只 DM 皱褶眼中，有 1 或 2 条透明线显示在 DM 层。3 只眼表现为数条弓形线，1 只眼表现为放射状。DM 皱褶会影响 DALK 术后的矫正视力（P = 0.018）。手术时年龄大于 20.5 岁和疾病持续时间大于 5.5 年是 DALK 术后 DM 皱褶形成的独立危险因素（比值比 5.39，95%置信区间：2.11-13.73，P < 0.001；6.60，95%置信区间：2.92-14.94，P < 0.001）。术前 Kmean、Kmax、中央角膜厚度、前房深度、性别、硬性透气性角膜接触镜佩戴史、Vogt 条纹、基质瘢痕和术中微穿孔对 DM 皱褶的发生无影响（P1 = 0.775，P2 = 0.896，P3 = 0.555，P4 = 0.182，P5 = 0.656，P6 = 0.237，P7 = 1.000，P8 = 0.587，P9 = 0.798）。