改良式深板层角膜移植术治疗圆锥角膜的效果

Clinical efficacy of modified deep lamellar keratoplasty for the treatment of keratoconus

目的评估改良式深板层角膜移植手术治疗中晚期圆锥角膜的效果及安全性。方法回顾性病例对照研究。纳入苏州大学附属理想眼科医院2018年6月至2020年6月中晚期圆锥角膜39例(42只眼)的临床资料。将患者按手术方式分为2组:A组20例(22只眼)行改良式前部深板层角膜移植术(MDALK), B组19例(20只眼)行常规前部深板层角膜移植术(DALK)。术后随访18个月, 比较两组术后裸眼视力、最佳矫正视力、球镜度、散光度、平均前角膜曲率、角膜内皮细胞丢失率;同时观察两组术后后弹力层皱褶以及其它并发症发生率。结果术后18个月, A组裸眼视力优于B组(t=-2.57, P=0.014);两组最佳矫正视力相近(t=-1.80, P=0.080);A组近视度低于B组(t=2.56, P=0.015)。两组散光、平均前角膜曲率及角膜内皮细胞丢失率差异无统计学意义(P>0.05)。两组均未发生术中或术后并发症, MDALK组后弹力层皱褶发生率低于DALK组(χ2=4.89, P=0.027)。结论中晚期圆锥角膜患者MDALK术后较DALK术后能获得更好的裸眼视力、有效降低后弹力层皱褶发生率, 更安全可靠。

Objective To evaluate the efficacy and safety of modified deep anterior lamellar keratoplasty in treating intermediate and advanced keratoconus.Methods This was a retrospective case control study.Total of 42 eyes of 39 patients diagnosed with intermediate and advanced keratoconus from Jun.2018 to Jun.2020 in the Lixiang Eye Hospital Affiliated to Soochow University were included.The patients were divided into two groups based on surgical methods.In group A,22 eyes of 20 cases were treated with modified deep anterior lamellar keratoplasty,and in group B,20 eyes of 19 cases were treated with deep anterior lamellar keratoplasty.The postoperative follow-up time was 18 months.The uncorrected visual acuity,best corrected visual acuity,spherical lens,astigmatism,average front corneal curvature and the rate of corneal endothelial cell losses of all patients were collected and compared.The incidence of Descemet’s folds and other complications were observed.Results At 18 months after operation,the uncorrected visual acuity of group A was better than that of group B(t=-2.57,P=0.014).The best corrected visual acuity was similar between the two groups(t=-1.80,P=0.080).The myopia diopter of group A was lower than that of group B(t=2.56,P=0.015).There was no significant difference in astigmatism,average anterior corneal curvature and the rate of corneal endothelial cells losses between the two groups(P>0.05).There were no intraoperative and postoperative complications in both groups.The rate of Descemet’s folds in group A was significantly lower than that in group B(χ^(2)=4.89,P=0.027).Conclusion Compared with deep anterior lamellar keratoplasty,modified deep anterior lamellar keratoplasty can obtain better uncorrected visual acuity,effectively reducing the incidence of Descemet’s folds in treating intermediate and advanced keratoconus.And it’s safer and more reliable.