Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received fu...Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.展开更多
Objective： To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty （FBDALK）. Methods： This is a retrospe...Objective： To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty （FBDALK）. Methods： This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity （UCVA）, best spectacle corrected visual acuity （BSCVA）, and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior （S-I） and nasal-temporal （N-T） corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center （S-I2 mm, S-14 mm, S-I6mm,, S-I8mm, N-T2mm, N-T4 mm, N-T6 mm, and N-T8 mm）, the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex （TA3 mm）, the astigmatic vector values J0 and J4s, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters （HOA3 mm and HOA6mm）. Statistical analysis was performed by SPSS 15.0. Results： A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was （28±7） months. The mean UCVA was 0.45±0.23 （IogMAR） （MAR： minimum angle of resolution） and the mean BSCVA was 0.19±0.15 （IogMAR）, which were all sig- nificantly positively correlated with postoperative TA3 mm and HOA3 turn. The mean S-I corneal thickness differences were （44.62±37.74） IJm, and the mean N-T was （38.57±32.29） pm. S-12 mm was significantly positively correlated with J0 （r=0.31）, J45 （r=0.42）, HOA3 mm （r=0.37）, and HOA6 mm （r=0.48）. S-14 mm and S-Is mm were significantly positively corre- lated with HOA3 mm （t=0.30, t=0.40） and HOA6 mm （r=0.46, r=0.35）. The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J45 （r=0.29）. Conclusions： In patients with ad- vanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.展开更多
基金Project (No. 2011C13029-2) supported by the Major Program for Science and Technology Research of Zhejiang Province, China
文摘Objective: To compare postoperative outcomes of full-bed deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in treating keratoconus. Methods: Seventy-five eyes of 64 patients who received full-bed DALK and 52 eyes of 51 patients who received PK between June 2000 and August 2010 were included in this retrospective study. Full-bed DALK was performed using Yao's hooking-detaching technique. PK was performed using a standard technique. Intraoperative and postoperative complications, visual acuity, rejection, graft survival, endothelial cell density, corneal sensation recovery, and re-innervation were compared between the two groups. Results: A best correct visual acuity of 0.5 or better was achieved in 90.7% of eyes after full-bed DALK and in 92.3% of eyes after PK (P=0.75). By the fifth postoperative year, graft endothelial cell loss reached 34.6% in the PK group vs. 13.9% in the full-bed DALK group (P<0.001). There were no statistical differences in corneal sensitivity recovery or corneal re-innervation between the groups (P>0.05). Intraoperative microperforation occurred in seven out of 75 (9.3%) eyes with a temporally postoperative double anterior chamber in two eyes in the full-bed DALK group. Postoperative complications in the PK vs. the full-bed DALK groups respectively were: rejection (7.7% vs. 0%, P=0.015), high intraocular pressure (IOP) (46.2% vs. 1.3%, P<0.001), secondary glaucoma (9.6% vs. 0%, P=0.006), complicated cataract (19.2% vs. 0%, P<0.001), and wound dehiscence (9.6% vs. 0%, P=0.006). Conclusions: Both full-bed DALK and PK can offer long-term satisfactory visual outcomes for keratoconus. Graft rejection, secondary glaucoma, complicated cataracts, and constant endothelial cell loss were observed in eyes only after PK.
基金Project supported by the Medical Scientific Research Foundation of Zhejiang Province(No.2018ZD007),China
文摘Objective： To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty （FBDALK）. Methods： This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity （UCVA）, best spectacle corrected visual acuity （BSCVA）, and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior （S-I） and nasal-temporal （N-T） corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center （S-I2 mm, S-14 mm, S-I6mm,, S-I8mm, N-T2mm, N-T4 mm, N-T6 mm, and N-T8 mm）, the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex （TA3 mm）, the astigmatic vector values J0 and J4s, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters （HOA3 mm and HOA6mm）. Statistical analysis was performed by SPSS 15.0. Results： A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was （28±7） months. The mean UCVA was 0.45±0.23 （IogMAR） （MAR： minimum angle of resolution） and the mean BSCVA was 0.19±0.15 （IogMAR）, which were all sig- nificantly positively correlated with postoperative TA3 mm and HOA3 turn. The mean S-I corneal thickness differences were （44.62±37.74） IJm, and the mean N-T was （38.57±32.29） pm. S-12 mm was significantly positively correlated with J0 （r=0.31）, J45 （r=0.42）, HOA3 mm （r=0.37）, and HOA6 mm （r=0.48）. S-14 mm and S-Is mm were significantly positively corre- lated with HOA3 mm （t=0.30, t=0.40） and HOA6 mm （r=0.46, r=0.35）. The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J45 （r=0.29）. Conclusions： In patients with ad- vanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.
