PDF(Pubmed)
Abstract：
OBJECTIVE: The aim of the study was to analyze the techniques and outcomes of deep anterior lamellar keratoplasty (DALK) done in eyes with healed hydrops.
METHODS: Thirty-one eyes with paracentral scars following acute hydrops underwent DALK and were included in the study. Manual layer-by-layer dissection with stromal air injection was done in all cases, keeping dissection of the site of preexisting perforation to the end.
RESULTS: Out of the 31 eyes, in 28 eyes, DALK could be completed, and in 3 eyes, procedure had to be converted to penetrating keratoplasty. Visual outcomes in all cases were good, with 26 out of 28 eyes (92.8%) achieving a best-corrected visual acuity (BCVA) of 6/12 or better. Preoperative mean BCVA of LogMAR 1.19 ± 0.27 improved to a postoperative mean BCVA of LogMAR 0.23 ± 0.08 (P < 0.00001). Postoperative mean refractive astigmatism at the last follow-up was -2.69 ± 0.82 D with postoperative a spherical equivalent of -2.31 ± 0.7 D. Complications included double anterior chamber in one eye and secondary angle closure in two eyes. Stromal rejection in one eye was managed with steroids and one eye with suture infiltrate needed selective suture removal.
CONCLUSIONS: Layer-by-layer dissection with limited air injection into the stroma has shown good visual outcomes in patients undergoing DALK following healed hydrops, and DALK can very well be the primary treatment option even in such cases with a paracentral posthydrops scar.
METHODS: Thirty-one eyes with paracentral scars following acute hydrops underwent DALK and were included in the study. Manual layer-by-layer dissection with stromal air injection was done in all cases, keeping dissection of the site of preexisting perforation to the end.
RESULTS: Out of the 31 eyes, in 28 eyes, DALK could be completed, and in 3 eyes, procedure had to be converted to penetrating keratoplasty. Visual outcomes in all cases were good, with 26 out of 28 eyes (92.8%) achieving a best-corrected visual acuity (BCVA) of 6/12 or better. Preoperative mean BCVA of LogMAR 1.19 ± 0.27 improved to a postoperative mean BCVA of LogMAR 0.23 ± 0.08 (P < 0.00001). Postoperative mean refractive astigmatism at the last follow-up was -2.69 ± 0.82 D with postoperative a spherical equivalent of -2.31 ± 0.7 D. Complications included double anterior chamber in one eye and secondary angle closure in two eyes. Stromal rejection in one eye was managed with steroids and one eye with suture infiltrate needed selective suture removal.
CONCLUSIONS: Layer-by-layer dissection with limited air injection into the stroma has shown good visual outcomes in patients undergoing DALK following healed hydrops, and DALK can very well be the primary treatment option even in such cases with a paracentral posthydrops scar.
摘要：
目的：本研究的目的是分析在积水愈合的眼睛中进行深板层角膜移植术（DALK）的技术和结果。
方法：31只眼急性水肿后出现中央旁瘢痕的患者接受DALK治疗，并纳入研究。在所有情况下都采用基质空气注射进行手动逐层解剖，将先前存在的穿孔部位解剖到底。
结果：在31只眼睛中，28只眼睛DALK可以完成,在三只眼睛里，手术必须转换为穿透性角膜移植术。所有病例的视力结果都很好，28只眼中有26只（92.8％）的最佳矫正视力（BCVA）达到6/12或更好。LogMAR的术前平均BCVA为1.19±0.27，术后平均BCVA为0.23±0.08（P<0.00001）。最后一次随访的术后平均屈光散光为-2.69±0.82D，术后球形等效为-2.31±0.7D。并发症包括一只眼睛的双前房和两只眼睛的继发性闭角。一只眼睛的基质排斥是用类固醇处理的，一只眼睛有缝线浸润需要选择性的缝线去除。
结论：在接受DALK治疗的患者中，向基质中注入有限的空气的逐层解剖显示出良好的视力结果，即使在这种情况下，DALK也可以很好地成为主要的治疗选择。
方法：31只眼急性水肿后出现中央旁瘢痕的患者接受DALK治疗，并纳入研究。在所有情况下都采用基质空气注射进行手动逐层解剖，将先前存在的穿孔部位解剖到底。
结果：在31只眼睛中，28只眼睛DALK可以完成,在三只眼睛里，手术必须转换为穿透性角膜移植术。所有病例的视力结果都很好，28只眼中有26只（92.8％）的最佳矫正视力（BCVA）达到6/12或更好。LogMAR的术前平均BCVA为1.19±0.27，术后平均BCVA为0.23±0.08（P<0.00001）。最后一次随访的术后平均屈光散光为-2.69±0.82D，术后球形等效为-2.31±0.7D。并发症包括一只眼睛的双前房和两只眼睛的继发性闭角。一只眼睛的基质排斥是用类固醇处理的，一只眼睛有缝线浸润需要选择性的缝线去除。
结论：在接受DALK治疗的患者中，向基质中注入有限的空气的逐层解剖显示出良好的视力结果，即使在这种情况下，DALK也可以很好地成为主要的治疗选择。
