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Abstract：
OBJECTIVE: To compare the outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PKP) in the management of medically unresponsive Acanthamoeba keratitis (AK).
METHODS: This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed.
RESULTS: The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group (P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group (P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group (P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups (P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively.
CONCLUSIONS: Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.
METHODS: This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed.
RESULTS: The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group (P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group (P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group (P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups (P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively.
CONCLUSIONS: Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.
摘要：
目的：比较大泡深前板层角膜移植术（BB-DALK）和穿透性角膜移植术（PKP）治疗医学无反应的棘阿米巴角膜炎（AK）的疗效。
方法：这项回顾性研究包括来自三级眼科护理中心的27只眼BB-DALK和24只眼PKP。术后2个月，根据使用共聚焦激光扫描显微镜的评估，将糖皮质激素滴眼液添加到治疗计划中。临床表现，最佳矫正视力（BCVA），术后屈光结果,移植物存活，分析棘阿米巴的复发情况。
结果：纳入研究的AK患者处于2期或3期，PKP组处于3期的患者百分比更高（P=0.003）。临床表现主要为角膜溃疡和环浸润，和内皮斑块，hypopyon,葡萄膜炎和青光眼在PKP组更为常见(P=0.007)。术后1年，两组的BCVA和移植物存活率无统计学差异。然而,术后3年,BCVA为0.71±0.64logMAR，移植物成活率89.5%,BB-DALK组的每平方毫米1899±125个细胞的内皮细胞密度明显优于PKP组（分别为P=0.010、0.046和0.032）。BB-DALK组3只眼(11.1%),PKP组2只眼(8.3%)出现棘阿米巴复发,但两组间差异无统计学意义(P=1.000)。在PKP组中,5和6只眼观察到免疫排斥反应和眼内压升高，分别。
结论：对于抗阿米巴药物无反应的AK患者，建议进行角膜移植。BB-DALK手术后可以保持视力和移植物存活。棘阿米巴复发与手术方法无关，而感染的角膜基质的完全解剖和糖皮质激素滴眼液的延迟处方对预防复发很重要。
方法：这项回顾性研究包括来自三级眼科护理中心的27只眼BB-DALK和24只眼PKP。术后2个月，根据使用共聚焦激光扫描显微镜的评估，将糖皮质激素滴眼液添加到治疗计划中。临床表现，最佳矫正视力（BCVA），术后屈光结果,移植物存活，分析棘阿米巴的复发情况。
结果：纳入研究的AK患者处于2期或3期，PKP组处于3期的患者百分比更高（P=0.003）。临床表现主要为角膜溃疡和环浸润，和内皮斑块，hypopyon,葡萄膜炎和青光眼在PKP组更为常见(P=0.007)。术后1年，两组的BCVA和移植物存活率无统计学差异。然而,术后3年,BCVA为0.71±0.64logMAR，移植物成活率89.5%,BB-DALK组的每平方毫米1899±125个细胞的内皮细胞密度明显优于PKP组（分别为P=0.010、0.046和0.032）。BB-DALK组3只眼(11.1%),PKP组2只眼(8.3%)出现棘阿米巴复发,但两组间差异无统计学意义(P=1.000)。在PKP组中,5和6只眼观察到免疫排斥反应和眼内压升高，分别。
结论：对于抗阿米巴药物无反应的AK患者，建议进行角膜移植。BB-DALK手术后可以保持视力和移植物存活。棘阿米巴复发与手术方法无关，而感染的角膜基质的完全解剖和糖皮质激素滴眼液的延迟处方对预防复发很重要。
