影响改良深板层角膜移植术治疗圆锥角膜长期疗效的相关因素分析

Long-term outcome and its associated factors of modified deep lamellar keratoplasty in the treatment of keratoconus

目的分析改良深板层角膜移植术(DLKP)治疗圆锥角膜的长期疗效及其影响因素。方法回顾性分析2007年3月至2009年9月在山东省眼科医院角膜病科诊断为圆锥角膜,由同一术者进行改良DLKP术并具完整记录的60例(69只眼)患者。随访时间为3年,观察并记录患者:术前裸眼视力(UCVA)、最佳矫正视力(BC-VA)、平均角膜曲率、眼轴、中央角膜厚度;术后3、12、24、36个月的UCVA、BCVA、等效球镜(SE)、平均角膜曲率、散光;术后3年或缝线全拆后经角膜RT-OCT所测得的中央角膜植床与植片的厚度,并观察患者术中及术后并发症。将术后3年BCVA分为≥0.5组(34只眼)与<0.5组(35只眼),对影响术后3年BCVA的相关因素进行分析。结果 (1)术前患者BCVA均<0.30,其中0.05以下者20只眼(28.5%);术后3年随访时BCVA均≥0.30,≥0.50者34只眼(48.6%)。(2)采用独立样本t检验比较术后3、12、24、36个月散光、术前眼轴、平均角膜曲率和中央角膜厚度具有显著差异,其余均不具备显著性差异。(3)采用Pearson相关分析及多元回归分析方法对影响术后3年BCVA的相关因素进行分析示:术前BCVA与术后3年BCVA具有显著的正相关性,而术前平均角膜曲率、眼轴、术后3年散光与术后3年BCVA则具有显著的负相关性。结论改良DLKP治疗圆锥角膜的长期疗效与术前BCVA、平均角膜曲率、眼轴、术后散光具有显著相关性。

Objective To evaluate the long-term outcome of deep lame.lir keratoplasty （DLKP） in treatment of keratceonus, and to discuss the related factors that related to the outcomes. Methods We reviewed clinical data of 60 1m- tients （69 eyes ） with keretoconus that received reed/fled DLKP between March 2007 and September 2009 at Shandong Eye Hospital. The follow-up period was 3 years in each case. Preoperative versus postoperative uncorrected visual acuity （ UC- VA）, best corrected visual acuity （BCVA）, average corneal curvature, ocular axis and the central corneal thickness were measured. UCVA, BCVA, spherical equivalent （SE）, average corneal curvature, and astigmatism changes were recorded preoperatively and postoperativeJy at 3 monthsl 12 months, 24 montts, and 36 months. Thickness of corneal planting bed and planting tablet were obtained by RT-OCT at 3 years after surgery or when sutures were cleared. Complications were also recorded. Results （1） thepreopemtiveBCVAwere 〈 0. 301n all eyes and 〈O. 05in20eyes{28.5%）;TheBCVAat the last follow-up visit wereO. 30 in all eyes and 90. 50 in 34 eyes （ 48.6% ）. （ 2 ） There were significant differences between pre-and post-operative astigmatism, optic axis and the central corneal thickness （ independent sample t-test） there was no difference between other pre-and post-operative measurements. （ 3 ） Pearson corre]atlon analysis and multiple re- gression analysis showed that preoperative BCVA is positively correlated to 3-year-postoperative BCVA. While average pre- operative corneal curvaturew preoperative eye axis, and postoperative astigmatism are negatively correlated to 3-year-pestoperstive BCVA. Conclusion The long-term outcome of DLKP is correlated to preoperative BCVA, average corneal curva- ture, eye axis, and postoperative astigmatism.