Krumeich J H, Daniel J, Winter M
Augenabteilung, Martin-Luther-Hospital Bochum.
Ophthalmologe. 1998 Nov;95(11):748-54. doi: 10.1007/s003470050347.
Despite the fact that deep lamellar keratoplasty (DLKP) is less invasive than to penetrating keratoplasty (PKP), this procedure is rarely performed. We therefore investigated whether or not the DLKP technique we employed can achieve stable improvement of visual acuity.
Thirty-three eyes underwent TLKP for treatment of superficial corneal pathology. The donor tissue transplanted was suitable for PKP. The donor lenticule was obtained on the artificial chamber of the guided trephine system (GTS). The recipient cornea was trephined with the same trephine to a depth of 680 microns. Manual dissection was performed with a bevel-up blade. The donor lenticule with the endothelium peeled off was then sutured in with a 10 x 0 nylon double-running antitorque suture. Cortisone-antibiotic eye drops were administered postoperatively.
Throughout the series no complications occurred. The mean best corrected visual acuity (BSCVA) over glasses was 0.29 (+/- 0.21) preoperatively, 0.1 (+/- 0.11) at 1 week, 0.33 (+/- 0.14) at 1 month, 0.5 (+/- 0.13) at 6 months, 0.61 (+/- 0.16) at 1 year and 0.63 (+/- 0.15) at 2 years. Clinically, we observed two subpopulations. In the first group of 87% of the cases, mean BSCVA was 0.67 (+/- 0.07) at 6 months. The remaining cases (BSCVA < or = 0.25 at 6 months) achieved a mean BSCVA of only 0.2 (+/- 0.04) at 1 year. Mean corneal astigmatism measured 2.93 D (+/- 1.62) preoperatively, 2.69 D (+/- 1.18) at 1 month, 2.09 D (+/- 1.07) at 1 year, and 2.22 D (+/- 1.11) at 2 years. We did not observe any graft rejection.
The technique reported for DLKP provides excellent matching of donor lenticule and recipient bed. Separation of donor and recipient stroma prevents interface healing. DLKP appears to be a safe procedure for the surgical treatment of superficial corneal pathology and may offer a clinically applicable alternative to PKP.
尽管深板层角膜移植术（DLKP）的侵入性低于穿透性角膜移植术（PKP），但该手术很少进行。因此，我们研究了我们采用的DLKP技术是否能实现视力的稳定改善。
33只眼睛接受TLKP治疗浅层角膜病变。移植的供体组织适用于PKP。供体晶状体在引导环钻系统（GTS）的人工前房获取。受体角膜用同一环钻钻至680微米深度。用斜面向上的刀片进行手动剥离。然后用10-0尼龙双行抗扭转缝线将剥除内皮的供体晶状体缝合进去。术后给予可的松-抗生素眼药水。
整个系列未发生并发症。术前戴眼镜的平均最佳矫正视力（BSCVA）为0.29（±0.21），1周时为0.1（±0.11），1个月时为0.33（±0.14），6个月时为0.5（±0.13），1年时为0.61（±0.16），2年时为0.63（±0.15）。临床上，我们观察到两个亚组。在第一组87%的病例中，6个月时平均BSCVA为0.67（±0.07）。其余病例（6个月时BSCVA≤0.25）1年时平均BSCVA仅为0.2（±0.04）。术前平均角膜散光为2.93 D（±1.62），1个月时为2.69 D（±1.18），1年时为2.09 D（±1.07），2年时为2.22 D（±1.11）。我们未观察到任何移植排斥反应。
所报道的DLKP技术能使供体晶状体与受体床完美匹配。供体和受体基质的分离可防止界面愈合。DLKP似乎是治疗浅层角膜病变的一种安全手术方法，可能为PKP提供一种临床适用的替代方法。
