Günaydın Nesrin Tutaş, Akmaz Berkay, Kandemir Baran
Department of Ophthalmology, Kartal City Hospital, University of Health Sciences Dr. Lutfi Kırdar, Istanbul, Turkey.
Department of Ophthalmology, Manisa City Hospital, Manisa, Turkey.
Arq Bras Oftalmol. 2023 Jul-Aug;86(4):337-344. doi: 10.5935/0004-2749.20230053.
This study aimed to compare the clinical outcomes following deep anterior lamellar keratoplasty and penetrating keratoplasty in contralateral eyes of the same patients.
In this retrospective, comparative case series, clinical outcome data included best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, endothelial cell density, endothelial cell loss, central corneal thickness, and intraocular pressure, which were evaluated at 6, 12, 24, and 36 months after deep anterior lamellar keratoplasty and penetrating keratoplasty. Additionally, complications were assessed.
Fifty-two eyes (26 patients) were included, of which 19 patients had keratoconus, 6 had stromal dystrophy, and 1 had post-laser-assisted in situ keratomileusis ectasia. The mean follow-up was 44.1 ± 10.5 months in the deep anterior lamellar keratoplasty Group and 47.9 ± 11.9 months in the penetrating keratoplasty Group. No significant differences were observed in the mean best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, and central corneal thickness between the deep anterior lamellar keratoplasty and penetrating keratoplasty Groups during follow-up. The endothelial cell density was significantly higher in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.022 and 0.013, respectively). Endothelial cell loss was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.025 and 0.001, respectively). Intraocular pressure was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Grroup at 6 months postoperatively (p=0.015). Microperforation occurred in 4 eyes (15%) during deep anterior lamellar keratoplasty surgery; however, penetrating keratoplasty was not required. No endothelial rejection occurred in the penetrating keratoplasty Group during follow-up.
Over the 3-year follow-up, endothelial cell loss and intraocular pressure in the deep anterior lamellar keratoplasty Group were significantly lower than those in the penetrating keratoplasty Group, while visual and refractive results were similar.
本研究旨在比较同一患者对侧眼行深板层角膜移植术和穿透性角膜移植术后的临床结果。
在这项回顾性比较病例系列研究中，临床结果数据包括最佳矫正视力、等效球镜度、屈光性散光、内皮细胞密度、内皮细胞损失、中央角膜厚度和眼压，在深板层角膜移植术和穿透性角膜移植术后6、12、24和36个月进行评估。此外，对并发症进行评估。
纳入52只眼（26例患者），其中19例患有圆锥角膜，6例患有基质营养不良，1例患有准分子激光原位角膜磨镶术后扩张。深板层角膜移植术组平均随访时间为44.1±10.5个月，穿透性角膜移植术组为47.9±11.9个月。随访期间，深板层角膜移植术组和穿透性角膜移植术组在平均最佳矫正视力、等效球镜度、屈光性散光和中央角膜厚度方面未观察到显著差异。术后24个月和36个月时，深板层角膜移植术组的内皮细胞密度显著高于穿透性角膜移植术组（分别为p=0.022和0.013）。术后24个月和36个月时，深板层角膜移植术组的内皮细胞损失显著低于穿透性角膜移植术组（分别为p=0.025和0.001）。术后6个月时，深板层角膜移植术组的眼压显著低于穿透性角膜移植术组（p=0.015）。深板层角膜移植术手术期间有4只眼（15%）发生微穿孔；然而，无需行穿透性角膜移植术。穿透性角膜移植术组随访期间未发生内皮排斥反应。
在3年的随访中，深板层角膜移植术组的内皮细胞损失和眼压显著低于穿透性角膜移植术组，而视力和屈光结果相似。
