大气泡技术联合湿剥法深板层角膜移植术

目的：介绍大气泡技术联合湿剥法深板层角膜移植术。方法：选择2016 年1 月至2017 年6 月期间在温州医科大学附属眼视光医院因单纯疱疹病毒性角膜炎（HSK）拟行大气泡技术联合湿剥法深板层角膜移植术患者59例（59眼）。术中行大气泡技术联合深板层角膜移植时,如遇2型大气泡或小气泡,改湿剥法完成手术。结果：59 眼均成功行深板层角膜移植术,无一例出现术中微穿孔,术中2 型大气泡占71%。结论：HSK患者术中可出现高比例2 型大气泡,出现2 型大气泡或小气泡改湿剥法钝性 分离,保留后弹力层前膜,手术安全。     

Comparison of Clinical Outcomes of Same-size Grafting between Deep Anterior Lamellar Keratoplasty and Penetrating Keratoplasty for Keratoconus

Purpose

To compare the clinical outcomes between deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) with same-size grafts in patients with keratoconus.

Methods

Medical records of 16 eyes from 15 patients treated from June 2005 through April 2011 were retrospectively reviewed. Patients with contact lens intolerance or who were poor candidates for contact lens fitting due to advanced cone underwent keratoplasty. The transplantations consisted of 11 DALK and 5 PKP with same-size grafting for keratoconus. Best-corrected visual acuity (BCVA), refractive error, corneal topographic profiling, and clinical course were compared between DALK and PKP groups.

Results

The follow-up period was 30 ± 17 months in the DALK group and 45 ± 20 months in the PKP group (p = 0.145). At final follow-up, the DALK and PKP groups achieved a BCVA (logarithm of the minimum angle of resolution) of 0.34 and 0.52, respectively (p = 0.980). Postoperative refractive error and mean simulated keratometric index showed myopic astigmatism in both groups without any statistical difference. Corneal irregularity index measured at 5 mm in the DALK group was less than that of the PKP group at 1-year follow-up (p = 0.021); however, at final follow-up, there was no longer a statistically significant difference. Endothelial cell counts were lower in the PKP group than in the DALK group at final follow-up (p = 0.021).

Conclusions

The optical outcomes of DALK with same-size grafts for keratoconus are comparable to those of PKP. Endothelial cell counts are more stable in DALK compared to PKP.     

Comparison of the Objective Optical Quality in Keratoconus Patients after Penetrating Keratoplasty versus Lamellar Keratoplasty

Objective: To evaluate the optical quality of keratoconus patients after penetrating keratoplasty (PKP) or lamellar keratoplasty (LKP) using a dual-channel optical quality analysis system (OQAS). Methods: This was a prospective study. A total of 40 keratoconus patients in Qingdao Eye Hospital were involved in thisstudy from January 2016 to December 2017. And they were divided into a PKP group (23 patients, 24 eyes) or LKP group (17 patients, 19 eyes), depending on the surgical selection. Visual acuity, astigmatism, the density of the corneal endothelium cells, objective scatter index (OSI), predicted visual acuity (PVA), modulation transfer function cut-off frequency (MTF cutoff), Strehl ratio (SR) and tear film analysis of the mean OSI with a dual-channel optical quality analysis system were compared. Data were analyzed using χ2 test and independent t test. Results: There was no statistically significant difference between the PKP group and the LKP group for best corrected visual acuity, and spherical and cylindrical powers. But there was a significant difference between the two groups in the density of the corneal endothelium cells (t=3.91, P<0.001). In addition, there were statistically significant differences between the PKP and the LKP groups for the MTF cutoff and PVA100 (t=2.58, P=0.01; t=2.66, P=0.01). There was also a statistically significant difference between the PKP group and the LKP group in the tear film analysis mean OSI (t=3.48, P<0.001). Conclusions: The objective optical qualities of keratoconus patients after PKP measured by OQAS are better than after LKP, and the MTF cutoff and contrast vision are also better.     

穿透性角膜移植术与板层角膜移植术治疗圆锥角膜术后客观视觉质量比较

目的：探讨采用双通道视觉质量分析系统（OQAS）评估圆锥角膜患者行穿透性角膜移植术（PKP）和 板层角膜移植术（LKP）后的客观视觉质量。方法：前瞻性临床研究。收集2016年1月至2017年12 月在青岛眼科医院因圆锥角膜行角膜移植的患者40例进行研究,其中PKP组23例（24眼）,LKP组 17例（19眼）,术前2组患者最佳矫正视力、屈光度和临床分期差异均无统计学意义,术后随访并应 用OQAS检查术后的客观视觉质量,检查指标包括客观散射指数（OSI）、调制传递函数（MTF）截止 频率、客观对比度视力和泪膜质量OSI变化。分类变量比较采用χ2 检验,组间连续变量比较采用独 立样本t检验。结果：术后随访23～25个月,PKP组和LKP组患者角膜植片均保持透明状态,2组间 最佳矫正视力、球镜度和柱镜度差异均无统计学意义,但PKP组角膜内皮细胞计数明显低于LKP组 （t=3.91,P<0.001）。PKP组的斯特列尔比、20%对比度视力、9%对比度视力以及OSI与LKP组相比, 差异均无统计学意义。PKP组的MTF截止频率和100%对比度视力较LKP组高,差异均有统计学意 义（t=2.58,P=0.01;t=2.66,P=0.01）。泪膜质量OSI在LKP组明显高于PKP组,差异有统计学意义 （t=3.48,P<0.001）。结论：双通道OQAS测量结果表明圆锥角膜患者行PKP术后的客观视觉质量优 于行LKP术后,PKP术后的MTF截止频率和对比度视力高于LKP术后。     

Visual Acuity Prognosis After Anterior Chamber Air Replacement to Prevent Pseudo-Anterior Chamber Formation After Deep Lamellar Keratoplasty

Purpose

To investigate the prognosis of patients who received anterior chamber air replacement after deep lamellar keratoplasty (DLKP) during the study period, January 1995 to April 2000.

Methods

The records were studied of 47 patients (54 eyes) (60.6 ± 21.3 years of age) who underwent DLKP at Dokkyo University Hospital. Visual acuity and endothelial cell loss were assessed in patients (1) with and without Descemet's membrane perforation; (2) with and without the use of anterior chamber air replacement, and for different durations of air replacement; and (3) in the presence or absence of a pseudo-anterior chamber, and in relation to its duration if present.

Results

No significant differences in relation to the above three items were found in endothelial cell loss in study years 1 to 5. Average best visual acuity was 0.61 in perforated eyes, 0.54 in unperforated eyes, 0.54 in eyes that received air replacement, and 0.57 in eyes that did not. The average best visual acuity was 0.38 in eyes with a pseudo-anterior chamber and 0.68 in eyes without one. There was a significant correlation between the duration of the pseudo-anterior chamber and loss of visual acuity.

Conclusions

The prolongation of a pseudo-anterior chamber eventually impairs visual acuity, whereas anterior chamber air replacement, used to prevent the development of a pseudo-anterior chamber, causes minimal endothelial cell damage. Anterior chamber air replacement, therefore, is an effective technique by which to prevent the development of a pseudo-anterior chamber.?Jpn J Ophthalmol 2007;51:181–184 © Japanese Ophthalmological Society 2007