两种深板层角膜移植术治疗圆锥角膜的比较研究

Comparison of two kinds of deep anterior lamellar keratoplasty for keratoconus

目的对比仅保留后弹力层和内皮细胞层植床的改良Anwar技术深板层角膜移植术(deep anterior lamellar keratoplasty performed with the modified Anwar technique,DALKa)和保留少量角膜基质的手工分离深板层角膜移植术(deep anterior lamellar keratoplasty performed with the manual technique,DALKm)治疗圆锥角膜的临床效果。方法对我院临床诊断明确的中晚期圆锥角膜40例42眼进行手术治疗,其中行DALKa者18眼为DALKa组,行DALKm者24眼为DALKm组。术后随访2a,对比分析术后最佳矫正视力、屈光状态和并发症情况。结果术后2a,最佳矫正视力≥0.5者DALKa组占94.4%(17/18),DALKm占54.2%(13/24),差异有统计学意义(P<0.05);两组最佳矫正视力≥1.0者分别占50.0%和25.0%,差异无统计学意义(P>0.05)。术后1a,DALKa组的近视度数和散光度数分别为(-3.08±1.13)D和(-3.00±1.02)D,DALKm组分别为(-2.63±1.02)D和(-3.33±1.17)D;术后2a,DALKa组近视度数和散光度数分别为(-3.97±1.07)D和(-2.09±1.15)D,DALKm组分别为(-2.10±0.98)D和(-3.05±1.20)D;术后1a、2a两组近视度数和散光度数差异均无统计数意义(均为P>0.05)。DALKa组术中发生后弹力层穿孔2眼,术后后弹力层皱褶4眼;DALKm组出现后弹力层皱褶、角膜炎、上皮病变及再次角膜移植者各3眼。结论相对DALKm,DALKa成功率更高,术后并发症更少,矫正视力更好,是治疗圆锥角膜的更好的术式。

Objective To compare the therapeutic outcomes of deep anterior lamellar keratoplasty performed with the modified Anwar technique（DALKa） leaving only the Descemet membrane and endothelium and the manual technique（DALKm） leaving a little stroma for keratoconus.Methods Forty patients（42 eyes） diagnosed as keratoconus received DALKa（18 eyes） and DALKm（24 eyes） in our hospital.The follow-up time was 2 years.The postoperative best corrected visual acuity,refractive results and complications were compared and analyzed.Results The postoperative best-corrected visual acuity at 2 years better than or equal to 0.5 was 94.4%（17/18） in DALKa group and 54.2%（13/24） in DALKm group,there was statistical difference（P0.05）.The postoperative best corrected visual acuity at 1 year better than or equal to 1.0 was 50.0% in DALKa group and 25.0% in DALKm group,there was no statistical difference（P0.05）.The postoperative mean myopia and astigmatism at 1 year was（-3.08±1.02）D,（-3.00±1.02）D in DALKa group,and（-2.63±1.02）D,（-3.33±1.77）D in DALKm group,which at 2 years was（-3.97±1.07）D,（-2.09±1.15）D in DALKa group and（-2.10±0.98）D,（-3.05±1.20）D in DALKm group,there was no statistical difference（both P0.05）.The complications in DALKa group included the perforation of grafting bed in 2 eyes,the wrinkle of Descemet’s membrane in 5 eyes,that in DALKm group included microbial keratitis,wrinkle of Descemet’s membrane,epitheliopathy and repeat corneal graft,each in 3 eyes.Conclusion There are high successful rate,few postoperative complications and better corrected visual acuity with DALKa for keratoconus.