Department of Ophthalmology, University of "Magna Graecia", Catanzaro, Italy.
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Cornea. 2023 Jul 1;42(7):815-820. doi: 10.1097/ICO.0000000000003082. Epub 2022 Nov 21.
The purpose of the study was to compare the clinical outcomes of large 9.0-mm diameter and conventional 8.0-mm big-bubble deep anterior lamellar keratoplasty (DALK).
In this comparative, retrospective interventional case series, medical records of 124 cases of large 9.0-mm diameter DALK from January 2017 to December 2019 and 133 conventional 8.0-mm DALK from January 2014 to December 2016 performed by a single surgeon for the indication of keratoconus were reviewed. Main outcome measures were best spectacle-corrected visual acuity (BSCVA), refractive astigmatism (RA), and postoperative complication rates.
Postoperative logarithm of the minimum angle of resolution BSCVA did not significantly differ between 9.0-mm and 8.0-mm DALK at any time points. Although the cumulative percentage of eyes achieving Snellen BSCVA of 20/40 or better was comparable between groups (9.0-mm DALK: 93%, 8.0-mm DALK: 90%, P = 0.571), the cumulative percentage of eyes achieving 20/20 or better (9.0-mm DALK: 44%, 8.0-mm DALK: 26%, P = 0.01) and 20/25 or better (9.0-mm DALK: 74%, 8.0-mm DALK: 59%, P = 0.03) was significantly higher in the 9.0-mm DALK group. RA was significantly lower in the 9.0-mm DALK group compared with the 8.0-mm DALK group during all time points ( P < 0.001). The percentage of eyes with RA less than or equal to 4.0 D was significantly lower in the 9.0-mm DALK patients (90%) compared with in 8.0-mm DALK group (72%) ( P = 0.002). Postoperative complication rates were similar between groups.
Compared with conventional 8.0-mm DALK, large 9.0-mm DALK can provide superior visual outcomes at higher levels of Snellen BSCVA and significantly lower degrees of astigmatism without an increased risk of immune rejection and graft failure.
本研究旨在比较大直径 9.0mm 和传统 8.0mm 大泡深层前板层角膜移植术（DALK）的临床结果。
本研究为回顾性对比干预性病例系列研究，纳入了 2017 年 1 月至 2019 年 12 月期间由同一位术者施行的大直径 9.0mm（124 例）和传统 8.0mm（133 例）DALK 治疗圆锥角膜的患者的临床资料。主要观察指标包括最佳矫正视力（BSCVA）、屈光性散光（RA）和术后并发症发生率。
在任何时间点，9.0mm 和 8.0mm DALK 的术后最小分辨角对数视力均无显著差异。虽然两组获得 Snellen BSCVA 20/40 或更好的累积百分比相似（9.0mm DALK：93%，8.0mm DALK：90%，P=0.571），但获得 20/20 或更好视力的累积百分比（9.0mm DALK：44%，8.0mm DALK：26%，P=0.01）和 20/25 或更好视力的累积百分比（9.0mm DALK：74%，8.0mm DALK：59%，P=0.03）在 9.0mm DALK 组中显著更高。与 8.0mm DALK 组相比，9.0mm DALK 组的 RA 在所有时间点均显著更低（P<0.001）。9.0mm DALK 组 RA 小于或等于 4.0D 的比例显著低于 8.0mm DALK 组（90%比 72%，P=0.002）。两组术后并发症发生率相似。
与传统 8.0mm DALK 相比，大直径 9.0mm DALK 可提供更高水平的 Snellen BSCVA 视觉结果，且 RA 显著更低，免疫排斥和移植物失败的风险无增加。
