Sarnicola Caterina, Sarnicola Vincenzo, Romani Andrea, Sarnicola Enrica
Ophthalmology Department, Ospedale San Donato AUSL Toscana Sud-est, Arezzo, Italy.
Clinica degli Occhi Sarnicola, Grosseto, Italy.
Eur J Ophthalmol. 2022 Oct 26:11206721221132622. doi: 10.1177/11206721221132622.
Residual bed thickness in DALK should be less than 80μm to provide optimal visual outcomes. "Peeling-off" is a manual DALK technique, which separates the anterior stroma by pulling the deep stromal lamellae following the plane of their lowest adhesion, which is usually very deep. The purpose of this study is to measure the residual bed thickness achievable with this technique.
Retrospective case series of "Peeling-off" DALK cases performed between January 2014 and January 2021 with at least 1 year of follow-up. Indications for DALK, intraoperative and postoperative complications, residual recipient bed thickness at 1 day and at 1 month after surgery, and postoperative best corrected visual acuity (BCVA) at 1 year of follow up were evaluated.
42 eyes (42 patients) underwent DALK performed with "Peeling-off" technique. Indications for surgery were keratoconus in 33 eyes and stromal scar in 9 eyes. "Peeling-off" technique was used as a rescue approach to perform a DALK after a failed Big-Bubble in all cases, and also failed Air-Visco-Bubble in some cases. No intraoperative and postoperative complications were recorded. Residual recipient bed thickness was deep and regular, measuring 42 microns at 1 day postoperative (range 21-65 microns) and 23 microns (range 17-26 microns) at 1 month postoperative. Mean postoperative BCVA at 1 year of follow up was 0.18 logMAR ± 0.09.
"Peeling-off" DALK is a valuable manual technique that achieves a deep stromal plane with optimal visual outcomes.
深板层角膜移植术（DALK）中的残余床厚度应小于80μm，以提供最佳视觉效果。“剥离法”是一种手动DALK技术，通过沿着最深粘连平面（通常非常深）牵拉深层基质板层来分离前基质。本研究的目的是测量该技术可达到的残余床厚度。
回顾性病例系列研究，纳入2014年1月至2021年1月期间采用“剥离法”进行DALK且至少随访1年的病例。评估DALK的适应证、术中及术后并发症、术后1天和1个月时的残余植床厚度，以及随访1年时的术后最佳矫正视力（BCVA）。
42只眼（42例患者）接受了采用“剥离法”的DALK手术。手术适应证为圆锥角膜33只眼，基质瘢痕9只眼。在所有病例中，“剥离法”均作为在大泡法失败后进行DALK的挽救方法，部分病例中空气-黏弹剂-气泡法也失败。未记录术中及术后并发症。残余植床厚度深且规则，术后1天测量为42微米（范围21-65微米），术后1个月为23微米（范围17-26微米）。随访1年时的平均术后BCVA为0.18 logMAR±0.09。
“剥离法”DALK是一种有价值的手动技术，可达到深层基质平面并获得最佳视觉效果。
