Janiszewska-Bil Dominika, Czarnota-Nowakowska Barbara, Krysik Katarzyna, Lyssek-Boroń Anita, Dobrowolski Dariusz, Grabarek Beniamin Oskar, Wylęgała Edward
Optegra Eye Clinic, 40-101 Katowice, Poland.
Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland.
J Clin Med. 2021 May 29;10(11):2421. doi: 10.3390/jcm10112421.
We compared the visual and refractive outcomes, intraocular pressure (IOP), endothelial cell loss (ECL), and adverse events in keratoconus patients after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) with the best corrected visual acuity (BCVA) below 0.3 (logMAR 0.52). This is a prospective, comparative cohort study of 90 eyes (90 patients) with a clinical diagnosis of keratoconus. Patients underwent a complete eye examination before the surgical approach, 6 and 12 months postoperatively that consisted of BCVA, refractive astigmatism (AS), central corneal thickness (CCT), IOP, and ECL. Secondary outcomes were adverse events related to the surgical procedure. With lower ECL and less adverse events, DALK was revealed to be beneficial over PK with similar visual outcomes. Results: There was no significant difference between the BCVA in the DALK and PK groups (at 6 months: 0.49 ± 0.17 vs. 0.48 ± 0.17; = 0.48; at 12 months: 0.54 ± 0.17 vs. 0.52 ± 0.14; = 0.41). The mean value of AS was significantly lower after the PK procedure when compared to DALK, after both 6 and 12 months of follow up ( < 0.001). The CCT in the DALK group was significantly lower when compared to the PK group (at 6 months: 452.1 ± 89.1 µm vs. 528.9 ± 69.9 µm, < 0.0001; at 12 months: 451.6 ± 83.5 µm vs. 525.5 ± 37.1 µm). The endothelial cell loss at 12 months after surgery was significantly lower after DALK when compared to PK ( < 0.0001). DALK transplantation should be considered as an alternative procedure in the surgical treatment of keratoconus.
我们比较了圆锥角膜患者在接受深板层角膜移植术（DALK）和穿透性角膜移植术（PK）后，最佳矫正视力（BCVA）低于0.3（logMAR 0.52）时的视觉和屈光结果、眼压（IOP）、内皮细胞丢失（ECL）及不良事件。这是一项针对90例（90只眼）临床诊断为圆锥角膜患者的前瞻性比较队列研究。患者在手术前、术后6个月和12个月接受了全面的眼部检查，包括BCVA、屈光性散光（AS）、中央角膜厚度（CCT）、IOP和ECL。次要结果是与手术相关的不良事件。结果显示，DALK与PK相比，ECL更低，不良事件更少，视觉结果相似。结果：DALK组和PK组的BCVA无显著差异（6个月时：0.49±0.17 vs. 0.48±0.17；P = 0.48；12个月时：0.54±0.17 vs. 0.52±0.14；P = 0.41）。在随访6个月和12个月后，PK术后AS的平均值均显著低于DALK（P < 0.001）。DALK组的CCT显著低于PK组（6个月时：452.1±89.1 µm vs. 528.9±69.9 µm，P < 0.0001；12个月时：451.6±83.5 µm vs. 525.5±37.1 µm）。与PK相比，DALK术后12个月时的内皮细胞丢失显著更低（P < 0.0001）。在圆锥角膜的手术治疗中，DALK移植应被视为一种替代手术方法。
