两种深板层角膜移植术治疗圆锥角膜的比较研究

目的对比仅保留后弹力层和内皮细胞层植床的改良Anwar技术深板层角膜移植术(deep anterior lamellar keratoplasty performed with the modified Anwar technique,DALKa)和保留少量角膜基质的手工分离深板层角膜移植术(deep anterior lamellar keratoplasty performed with the manual technique,DALKm)治疗圆锥角膜的临床效果。方法对我院临床诊断明确的中晚期圆锥角膜40例42眼进行手术治疗,其中行DALKa者18眼为DALKa组,行DALKm者24眼为DALKm组。术后随访2a,对比分析术后最佳矫正视力、屈光状态和并发症情况。结果术后2a,最佳矫正视力≥0.5者DALKa组占94.4%(17/18),DALKm占54.2%(13/24),差异有统计学意义(P<0.05);两组最佳矫正视力≥1.0者分别占50.0%和25.0%,差异无统计学意义(P>0.05)。术后1a,DALKa组的近视度数和散光度数分别为(-3.08±1.13)D和(-3.00±1.02)D,DALKm组分别为(-2.63±1.02)D和(-3.33±1.17)D;术后2a,DALKa组近视度数和散光度数分别为(-3.97±1.07)D和(-2.09±1.15)D,DALKm组分别为(-2.10±0.98)D和(-3.05±1.20)D;术后1a、2a两组近视度数和散光度数差异均无统计数意义(均为P>0.05)。DALKa组术中发生后弹力层穿孔2眼,术后后弹力层皱褶4眼;DALKm组出现后弹力层皱褶、角膜炎、上皮病变及再次角膜移植者各3眼。结论相对DALKm,DALKa成功率更高,术后并发症更少,矫正视力更好,是治疗圆锥角膜的更好的术式。

Comparison of two kinds of deep anterior lamellar keratoplasty for keratoconus

Objective To compare the therapeutic outcomes of deep anterior lamellar keratoplasty performed with the modified Anwar technique(DALKa) leaving only the Descemet membrane and endothelium and the manual technique(DALKm) leaving a little stroma for keratoconus.Methods Forty patients(42 eyes) diagnosed as keratoconus received DALKa(18 eyes) and DALKm(24 eyes) in our hospital.The follow-up time was 2 years.The postoperative best corrected visual acuity,refractive results and complications were compared and analyzed.Results The postoperative best-corrected visual acuity at 2 years better than or equal to 0.5 was 94.4%(17/18) in DALKa group and 54.2%(13/24) in DALKm group,there was statistical difference(P<0.05).The postoperative best corrected visual acuity at 1 year better than or equal to 1.0 was 50.0% in DALKa group and 25.0% in DALKm group,there was no statistical difference(P>0.05).The postoperative mean myopia and astigmatism at 1 year was(-3.08±1.02)D,(-3.00±1.02)D in DALKa group,and(-2.63±1.02)D,(-3.33±1.77)D in DALKm group,which at 2 years was(-3.97±1.07)D,(-2.09±1.15)D in DALKa group and(-2.10±0.98)D,(-3.05±1.20)D in DALKm group,there was no statistical difference(both P>0.05).The complications in DALKa group included the perforation of grafting bed in 2 eyes,the wrinkle of Descemet’s membrane in 5 eyes,that in DALKm group included microbial keratitis,wrinkle of Descemet’s membrane,epitheliopathy and repeat corneal graft,each in 3 eyes.Conclusion There are high successful rate,few postoperative complications and better corrected visual acuity with DALKa for keratoconus.