Morgan Stephen, Mukhija Ritika, Nanavaty Mayank A
Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK.
J Ophthalmol. 2025 Jul 17;2025:4101770. doi: 10.1155/joph/4101770. eCollection 2025.
To analyse the outcomes of deep anterior lamellar keratoplasty (DALK) in cases with intraoperative Descemet membrane (DM) perforation. This is a literature review reporting outcomes of DALK with DM perforation. Studies where DALK was performed in the event of intraoperative DM perforation were included. Studies that did not separate analysis between those with and without DM perforation were excluded. The primary outcome was best-corrected distance visual acuity (BCVA). Secondary outcomes were endothelial cell density (ECD), graft survival, rejection rates, double anterior chamber and conversion to penetrating keratoplasty (PK). Data from the included studies were collated to compare the outcomes of DALK with intraoperative DM perforation vs. DALK without DM perforation. Eleven retrospective case series (357 eyes) were included. DM perforations were classified as micro- ( = 236) or macroperforations ( = 106). Mean weighted preoperative BCVA was 1.11 ± 0.36 logMAR and 1.13 ± 0.52 logMAR in perforation and nonperforation groups, respectively (=0.53), improving to 0.35 ± 0.37 logMAR and 0.39 ± 0.07 logMAR at 12 months postoperatively (=0.02). Graft rejection rates were 1.25% and 1.6% in the perforated and nonperforated groups, respectively, and primary graft failure rates were 4% and 3.74%, respectively. The mean postoperative ECD was 1662.41 ± 319.16 cells/mm in the perforation group. Amongst those cases with DM perforation, double anterior chamber requiring rebubbling occurred in 22.4% of cases, and conversion to PK was 4.23%. DALK can achieve comparable long-term outcomes in the presence of DM perforation. Micro- and some macroperforations can often be managed without conversion to PK, with good long-term outcomes.
分析术中后弹力层（DM）穿孔的深板层角膜移植术（DALK）病例的手术效果。这是一篇关于术中DM穿孔的DALK手术效果的文献综述。纳入了术中发生DM穿孔时进行DALK手术的研究。排除未对有和没有DM穿孔的病例进行单独分析的研究。主要结局指标是最佳矫正远视力（BCVA）。次要结局指标是内皮细胞密度（ECD）、植片存活率、排斥反应发生率、双前房和转为穿透性角膜移植术（PK）的情况。对纳入研究的数据进行整理，以比较术中DM穿孔的DALK与未发生DM穿孔的DALK的手术效果。纳入了11个回顾性病例系列（357只眼）。DM穿孔分为微小穿孔（=236例）或大穿孔（=106例）。穿孔组和非穿孔组术前平均加权BCVA分别为1.11±0.36 logMAR和1.13±0.52 logMAR（P=0.53），术后12个月分别提高到0.35±0.37 logMAR和0.39±0.07 logMAR（P=0.02）。穿孔组和非穿孔组的植片排斥反应发生率分别为1.25%和1.6%，原发性植片失败率分别为4%和
