Kodavoor Shreesha Kumar, Soundarya B, Dandapani Ramamurthy
Cornea, Cataract and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India.
Oman J Ophthalmol. 2024 Jun 27;17(2):210-213. doi: 10.4103/ojo.ojo_242_22. eCollection 2024 May-Aug.
The aim of the study was to analyze the techniques and outcomes of deep anterior lamellar keratoplasty (DALK) done in eyes with healed hydrops.
Thirty-one eyes with paracentral scars following acute hydrops underwent DALK and were included in the study. Manual layer-by-layer dissection with stromal air injection was done in all cases, keeping dissection of the site of preexisting perforation to the end.
Out of the 31 eyes, in 28 eyes, DALK could be completed, and in 3 eyes, procedure had to be converted to penetrating keratoplasty. Visual outcomes in all cases were good, with 26 out of 28 eyes (92.8%) achieving a best-corrected visual acuity (BCVA) of 6/12 or better. Preoperative mean BCVA of LogMAR 1.19 ± 0.27 improved to a postoperative mean BCVA of LogMAR 0.23 ± 0.08 ( < 0.00001). Postoperative mean refractive astigmatism at the last follow-up was -2.69 ± 0.82 D with postoperative a spherical equivalent of -2.31 ± 0.7 D. Complications included double anterior chamber in one eye and secondary angle closure in two eyes. Stromal rejection in one eye was managed with steroids and one eye with suture infiltrate needed selective suture removal.
Layer-by-layer dissection with limited air injection into the stroma has shown good visual outcomes in patients undergoing DALK following healed hydrops, and DALK can very well be the primary treatment option even in such cases with a paracentral posthydrops scar.
本研究旨在分析对水肿已愈合的眼睛进行深板层角膜移植术（DALK）的技术及效果。
31只因急性水肿后出现旁中心瘢痕的眼睛接受了DALK并纳入本研究。所有病例均采用手动分层剥离并注入基质空气，将先前穿孔部位的剥离留到最后。
31只眼中，28只眼成功完成DALK，3只眼手术不得不转为穿透性角膜移植术。所有病例的视觉效果良好，28只眼中有26只眼（92.8%）最佳矫正视力（BCVA）达到6/12或更好。术前平均LogMAR视力为1.19±0.27，术后平均BCVA改善为LogMAR 0.23±0.08（<0.00001）。最后一次随访时术后平均屈光性散光为-2.69±0.82 D，术后等效球镜度为-2.31±0.7 D。并发症包括1只眼出现双前房和2只眼出现继发性房角关闭。1只眼的基质排斥反应通过类固醇治疗，1只眼的缝线浸润需要选择性拆除缝线。
对水肿已愈合的眼睛进行DALK时，采用有限空气注入基质的分层剥离法已显示出良好的视觉效果，即使在旁中心水肿后瘢痕的病例中，DALK也完全可以作为主要治疗选择。
