深板层角膜移植与穿透性角膜移植治疗圆锥角膜的长期内皮细胞活力比较。

Long-Term Endothelial Cell Viability After Deep Anterior Lamellar Versus Penetrating Keratoplasty for Keratoconus.

机构信息

From the Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey.

出版信息

Exp Clin Transplant. 2023 Jul;21(7):599-606. doi: 10.6002/ect.2023.0069.

DOI:10.6002/ect.2023.0069

PMID:37584541

Abstract

OBJECTIVES

We compared long-term endothelial cell survival after penetrating versus after deep anterior lamellar keratoplasty for keratoconus.

MATERIALS AND METHODS

We retrospectively compared 64 eyes of 55 patients who had penetrating keratoplasty and 40 eyes of 37 patients who had deep anterior lamellar keratoplasty for keratoconus (October 2003-February 2021). Best-corrected visual acuity, Goldmann applanation tonometry, fundus examination with 90D lens, and specular microscopy with CEM-530 (Nidek) were performed preoperatively and every 6 months postoperatively. Main outcomes were endothelial cell density, central corneal thickness, and visual acuity. Secondary outcomes were coefficient of variation, hexagonality, graft rejection episodes, and graft clarity.

RESULTS

We found no significant differences between the 2 treatment groups regarding patient age, donor age, preoperative vision, central corneal thickness, and recipient-donor trephine diameters. Mean follow-up was 92.5 months. In deep anterior lamellar keratoplasty, the endothelium was preserved significantly better for 10 years versus for penetrating keratoplasty. Mean endothelial density in penetrating versus deep anterior lamellar keratoplasty was 2006.7 versus 2354.7 cells/mm2 at 1 year (P = .010), 1170.5 versus 2048.2 at 5 years (P <.001), and 972.5 versus 1831.6 at 10 years (P < .001). Cumulative endothelial cell loss was 43% and 19.7% at 10 years for penetrating and anterior lamellar keratoplasty, respectively. Significantly more thickening of central cornea was shown in penetrating keratoplasty after 7 years. Corneal thickness was 583.0 µm in penetrating and 545.1 µm in deep anterior lamellar keratoplasty (P = .002) at 10 years. Vision gain and coefficient of variation were similar. Hexagonality decreased significantly in both groups at 10 years. Rates of rejection were 12.5% in penetrating and 7.5% in deep anterior lamellar keratoplasty. Graft survival rates were 97.5% and 96.9%, respectively.

CONCLUSIONS

In keratoconus, endothelial vitality is better preserved with deep anterior lamellar keratoplasty than with penetrating keratoplasty over a 10-year follow-up.

摘要

目的

我们比较了穿透性角膜移植术与深层前板层角膜移植术治疗圆锥角膜后内皮细胞的长期存活率。

材料与方法

我们回顾性比较了 2003 年 10 月至 2021 年 2 月期间 55 例 64 眼穿透性角膜移植术和 37 例 40 眼深层前板层角膜移植术治疗圆锥角膜的患者。术前和术后每 6 个月进行最佳矫正视力、压平眼压计、90D 晶状体眼底检查和 CEM-530（尼德克）共焦显微镜检查。主要结局是内皮细胞密度、中央角膜厚度和视力。次要结局是变异系数、六边性、移植物排斥反应和移植物清晰度。

结果

两组患者的年龄、供体年龄、术前视力、中央角膜厚度和受者-供体环钻直径无显著差异。平均随访时间为 92.5 个月。在深层前板层角膜移植术中，内皮细胞保存明显优于穿透性角膜移植术，10 年内的结果更好。穿透性角膜移植术与深层前板层角膜移植术的平均内皮密度分别为 2006.7 个/mm2 与 2354.7 个/mm2（P =.010）、1170.5 个/mm2 与 2048.2 个/mm2（P <.001）、972.5 个/mm2 与 1831.6 个/mm2（P <.001）。10 年后穿透性角膜移植术和前板层角膜移植术的内皮细胞丧失率分别为 43%和 19.7%。7 年后穿透性角膜移植术的中央角膜厚度明显增厚。10 年后穿透性角膜移植术的角膜厚度为 583.0 µm，深层前板层角膜移植术为 545.1 µm（P =.002）。视力提高和变异系数相似。两组的六边形度在 10 年内均显著下降。穿透性角膜移植术的排斥率为 12.5%，深层前板层角膜移植术为 7.5%。移植物存活率分别为 97.5%和 96.9%。