Wei Wei Dayna Yong, Shen Liang, Manotosh Ray, Wee Tien Anna Tan, Hui-Chen Charmaine Chai
Department of Ophthalmology, National University Hospital, National University Health System, Singapore.
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
J Curr Ophthalmol. 2022 Apr 16;34(1):30-36. doi: 10.4103/joco.joco_211_21. eCollection 2022 Jan-Mar.
To study the effect of intraocular pressure (IOP) on refractive outcomes after deep anterior lamellar keratoplasty (DALK).
This retrospective study included eyes which underwent DALK. DALK technique involved either modified Anwar big-bubble if possible or manual anterior lamellar dissection. Our main outcome measures are postoperative IOP and refractive outcomes at postoperative week and months 1, 3, 6, and 12.
Fifty-nine eyes of 59 patients were included. DALK was performed for optical (93.2%) and tectonic (6.8%) purposes. 76.3% of the patients had keratoconus. Anwar's big-bubble technique was successful in 30 cases. Linear mixed-model was used to analyze the effect of the highest postoperative IOP measured prior to measurement of postoperative cylinder. Patients with greater maximum postoperative IOP measured had worse postoperative cylinder ( = 0.015) and spherical equivalent ( = 0.012). Those with IOP more than 21 mmHg had worse postoperative cylinder ( = 0.050) and spherical equivalent ( = 0.054). The method of DALK and presence of suture removal were not shown to statistically affect postoperative cylinder.
Our study shows a positive correlation between postoperative IOP and worse spherical equivalent and cylinder post-DALK, emphasizing the need for good IOP control with IOP-lowering medication(s).
研究眼压（IOP）对深前板层角膜移植术（DALK）后屈光结果的影响。
这项回顾性研究纳入了接受DALK的眼睛。DALK技术尽可能采用改良的安瓦尔大泡法或手动前板层剥离法。我们的主要观察指标是术后眼压以及术后第1周、第3个月、第6个月和第12个月的屈光结果。
纳入了59例患者的59只眼。进行DALK的目的为光学性（93.2%）和结构性（6.8%）。76.3%的患者患有圆锥角膜。安瓦尔大泡技术在30例中成功。采用线性混合模型分析术后柱镜测量前测得的最高术后眼压的影响。术后测得的最大眼压较高的患者术后柱镜（P = 0.015）和球镜等效度（P = 0.012）较差。眼压超过21 mmHg的患者术后柱镜（P = 0.050）和球镜等效度（P = 0.054）较差。未显示DALK方法和缝线拆除情况对术后柱镜有统计学影响。
我们的研究表明，DALK术后眼压与较差的球镜等效度和柱镜之间存在正相关，强调需要使用降眼压药物良好控制眼压。
