Department of Cornea and Refractive Services, The Eye Foundation Hospital, Coimbatore, Tamil Nadu, India.
Department of Cornea, Cataract and Refractive Services, The Eye Foundation Hospital, Coimbatore, Tamil Nadu, India.
Indian J Ophthalmol. 2022 Oct;70(10):3501-3507. doi: 10.4103/ijo.IJO_655_22.
To analyze the complications in patients managed with deep anterior lamellar keratoplasty (DALK) for diseases of the anterior corneal stroma.
This is a retrospective analysis of all the patients who underwent DALK in a tertiary care center in South India from 2010 to 2020. A total of 474 eyes in 373 patients were included in the study. Patients who underwent DALK for advanced keratoconus, keratoconus with Bowman's membrane scar, healed hydrops, macular corneal opacity, macular corneal dystrophy, granular corneal dystrophy, spheroidal degeneration, pellucid marginal degeneration, post-laser-assisted in situ keratomileusis ectasia, descematocele, post-collagen cross-linking aborted melt and dense scar, and post-radial keratotomy were included in the study. The patients were followed up for 17.2 +/- 9.2 months (1-9 years).
Complications noted in the surgery were intra-operatively Descemet's membrane perforation in 31 eyes (6.54%), post-operatively secondary glaucoma in 16 eyes (3.37%), cataract in seven eyes (1.47%), suture-related complications in five eyes (1.05%), graft rejection in three eyes (0.63%), traumatic dehiscence in two eyes (0.42%), filamentary keratitis in two eyes (0.42%), interface infiltrate in one eye (0.21%), and recurrence of disease in four eyes (7.14%) out of 57 eyes with corneal dystrophy.
DALK as an alternative to penetrating keratoplasty for anterior corneal stromal diseases. It has become an automatic choice for diseases of the anterior cornea requiring keratoplasty. Complications can occur at any stage of surgery; however, if identified and managed early, they can result in optimal outcome.
分析深板层角膜移植术（DALK）治疗前部角膜基质疾病的并发症。
这是对印度南部一家三级护理中心 2010 年至 2020 年间接受 DALK 的所有患者进行的回顾性分析。共有 373 名患者的 474 只眼纳入研究。接受 DALK 治疗的患者包括：晚期圆锥角膜、伴有 Bowman 膜瘢痕的圆锥角膜、愈合性水肿、黄斑角膜混浊、黄斑角膜营养不良、颗粒状角膜营养不良、球形变性、边缘透明性营养不良、激光辅助原位角膜磨镶术后扩张、前房积血、胶原交联术失败性融解和致密瘢痕、放射状角膜切开术后。患者随访 17.2+/-9.2 个月（1-9 年）。
术中并发症为 31 只眼（6.54%）发生 Descemet 膜穿孔，术后发生继发性青光眼 16 只眼（3.37%）、白内障 7 只眼（1.47%）、缝线相关并发症 5 只眼（1.05%）、移植物排斥反应 3 只眼（0.63%）、创伤性裂开 2 只眼（0.42%）、丝状角膜炎 2 只眼（0.42%）、界面浸润 1 只眼（0.21%），4 只眼（7.14%）发生角膜营养不良的患者疾病复发。
DALK 作为前部角膜基质疾病穿透性角膜移植术的替代方法，已成为需要角膜移植的前部角膜疾病的首选方法。手术各阶段均可发生并发症；但如果早期发现并及时处理，可获得最佳效果。
