Corneal back surface radius after DSEK and DSAEK: a comparative single surgeon case control study
Tóm tắt
The purpose of this study was to analyse and compare the visual and refractive results after DSEK with manual donor dissection and DSAEK with microkeratome-assisted donor dissection in a retrospective unmasked case control study. DSEK was performed in 15 eyes of 15 patients (74.9 ± 7.9 years; 4♂, 11♀). DSAEK was performed in 15 eyes of 15 patients (76.5 ± 6.6 years; 4♂, 11♀) using the Carriazo-Pendular-microkeratome and Schwindt artificial anterior chamber. The best corrected visual acuity (BCVA), corneal geometry assessed using Scheimpflug photography (SP) and anterior segment optical coherence tomography (AS-OCT) was regularly measured in 15 matched pairs receiving DSEK or DSAEK. Mean BCVA improved from 1.1 ± 0.5 to 0.5 ± 0.2 logMAR (p = 0.001) after DSEK and from 1.0 ± 0.5 to 0.2 ± 0.2 logMAR (p = 0.001) in the DSAEK-group. After 6 months, BCVA was significantly better in the DSAEK-group. Corneal refractive power decreased from 36.9 ± 1.5 to 35.9 ± 1.3 D (p = 0.01) in the DSEK-group and from 37.7 ± 1.6 to 36.4 ± 1.6 D (p = 0.01) in the DSAEK-group. The corneal back surface radius changed from 6.05 ± 1.6 to 5.82 ± 0.45 in the DSEK (p = 0.03) and from 6.72 ± 0.96 to 5.39 ± 0.33 in the DSAEK-group (p = 0.01). Mean central corneal thickness (CCT) measured by SP decreased from 741 ± 105 to 605 ± 63 µm (p = 0.26) after DSEK and from 700 ± 98 to 607 ± 88 µm (p = 0.01) after DSAEK. At no point in time during follow-up, mean CCT was significantly different in both groups. The ratio between central and peripheral transplant thickness decreased slightly from 0.65 ± 0.16 to 0.59 ± 0.16 after DSEK (p = 0.57) and from 0.52 ± 0.08 to 0.43 ± 0.14 after DSAEK (p = 0.17). The ratio difference between DSEK and DSAEK-groups was not statistically significant. The use of a pendular microkeratome for DSAEK results in faster visual rehabilitation but does not decrease the surgically induced change of cornea-based hyperopisation which is due to posterior corneal curvature.
Tài liệu tham khảo
Mackensen G (1978) Backward glance to a quarter century of ophthalmology. A balance. Hippokrates 49:223–230
Zirm EK (1989) Eine erfolgreiche totale Keratoplastik (A successful total keratoplasty). 1906. Refract Corneal Surg 5:258–261
Tillett CW (1956) Posterior lamellar keratoplasty. Am J Ophthalmol 41:530–533
Melles GR, Lander F, Rietveld FJ, Remeijer L, Beekhuis WH, Binder PS (1999) A new surgical technique for deep stromal, anterior lamellar keratoplasty. Br J Ophthalmol 83:327–333
Melles GR, Eggink FA, Lander F, Pels E, Rietveld FJ, Beekhuis WH, Binder PS (1998) A surgical technique for posterior lamellar keratoplasty. Cornea 17:618–626
Gorovoy MS (2006) Descemet-stripping automated endothelial keratoplasty. Cornea 25:886–889
de Ortueta D (2008) Planar flaps with the Carriazo-Pendular microkeratome. J Refract Surg 24(4):322–323
Melles GR, Lander F, Nieuwendaal C (2002) Sutureless, posterior lamellar keratoplasty: a case report of a modified technique. Cornea 21:325–327
Weller KK, Unterlauft JD, Geerling G (2010) 1-year results after posterior lamellar keratoplasty with manually dissected donor tissue. Klin Monbl Augenheilkd 227:460–466
Melles GR, Wijdh RH, Nieuwendaal CP (2004) A technique to excise the Descemet membrane from a recipient cornea (descemetorhexis). Cornea 23:286–288
Melles GR, Kamminga N (2003) Techniques for posterior lamellar keratoplasty through a scleral incision. Ophthalmologe 100:689–695
Melles GR, Lander F, Rietveld FJ (2002) Transplantation of Descemet’s membrane carrying viable endothelium through a small scleral incision. Cornea 21:415–418
Melles GR, Rietveld FJ, Beekhuis WH, Binder PS (1999) A technique to visualize corneal incision and lamellar dissection depth during surgery. Cornea 18:80–86
Melles GR, Lander F, Beekhuis WH, Remeijer L, Binder PS (1999) Posterior lamellar keratoplasty for a case of pseudophakic bullous keratopathy. Am J Ophthalmol 127:340–341
Rudolph M, Laaser K, Bachmann BO, Cursiefen C, Epstein D, Kruse FE (2012) Corneal higher-order aberrations after Descemet’s membrane endothelial keratoplasty. Ophthalmology 119:528–535
Bahar I, Kaiserman I, Srinivasan S, Ya-Ping J, Slomovic AR, Rootman DS (2008) Comparison of three different techniques of corneal transplantation for keratoconus. Am J Ophthalmol 146:905–912
Terry MA, Shamie N, Chen ES, Phillips PM, Shah AK, Hoar KL, Friend DJ (2009) Endothelial keratoplasty for Fuchs’ dystrophy with cataract: complications and clinical results with the new triple procedure. Ophthalmology 116:631–639
Koenig SB, Covert DJ, Dupps WJ Jr, Meisler DM (2007) Visual acuity, refractive error, and endothelial cell density six months after Descemet stripping and automated endothelial keratoplasty (DSAEK). Cornea 26:670–674
Price MO, Price FW Jr (2006) Descemet’s stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue. Ophthalmology 113:1936–1942
Price FW Jr, Price MO (2005) Descemet’s stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg 21:339–345
Scorcia V, Matteoni S, Scorcia GB, Scorcia G, Busin M (2009) Pentacam assessment of posterior lamellar grafts to explain hyperopization after Descemet’s stripping automated endothelial keratoplasty. Ophthalmology 116:1651–1655
Tarnawska D, Wylegala E (2010) Monitoring cornea and graft morphometric dynamics after Descemet stripping and endothelial keratoplasty with anterior segment optical coherence tomography. Cornea 29:272–277
Holz HA, Meyer JJ, Espandar L, Tabin GC, Mifflin MD, Moshirfar M (2008) Corneal profile analysis after Descemet stripping endothelial keratoplasty and its relationship to postoperative hyperopic shift. J Cataract Refract Surg 34:211–214
Rao SK, Leung CK, Cheung CY, Li EY, Cheng AC, Lam PT, Lam DS (2008) Descemet stripping endothelial keratoplasty: effect of the surgical procedure on corneal optics. Am J Ophthalmol 145:991–996