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Deep Anterior Lamellar Keratoplasty for Keratoconus: Multisurgeon Results.

Abstract：

PURPOSE:To examine clinical outcomes in deep anterior lamellar keratoplasty (DALK) for keratoconus using contemporary techniques in a multisurgeon public healthcare setting. DESIGN:Consecutive, retrospective case series. METHODS:Setting: Moorfields Eye Hospital, London, United Kingdom. STUDY POPULATION:Consecutive cases of keratoconus treated with non-laser assisted DALK from September 1, 2012, to September 31, 2016. OBSERVATION PROCEDURE:Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived for analysis. MAIN OUTCOME MEASURES:Graft failure rate and percentage of patients with corrected distance visual acuity (CDVA) ≥20/40 within 1 year of surgery and at final review after suture removal. RESULTS:Three hundred fifty-seven eyes of 338 patients undergoing DALK (91.3% big-bubble technique attempted) were analyzed. A total of 4.2% (95% confidence interval [CI] 2.4%-6.8%) of corneal transplants had failed within the follow-up period (21.8 ± 11.4 months), and 75.9% of eyes had CDVA ≥20/40 within 1 year of surgery, rising to 81% after suture removal. Forty-two primary surgeons (31 trainees) participated. Intraoperative perforation of Descemet membrane occurred in 45.4% of eyes. A total of 24.1% were converted to penetrating keratoplasty (PK) intraoperatively. Conversion to PK increased the risk of transplant rejection (P = .026; odds ratio [OR] 1.94; 95% CI 1.1-3.5) and secondary glaucoma (P = .016; OR 4.0; 95% CI 1.3-12.4). Transplant rejection increased the risk of graft failure both overall (P = .017; OR = 3.9; 95% CI 1.4-11.0) and when cases converted to PK were excluded (P = .028; OR = 3.35; 95% CI 1.1-9.9). CONCLUSION:DALK for keratoconus achieves early results similar to those published for PK in a multisurgeon setting. Conservative management of intraoperative Descemet membrane perforation, where possible, may be safer than conversion to PK.

journal_name

Am J Ophthalmol

journal_title

American journal of ophthalmology

authors

Gadhvi KA,Romano V,Fernández-Vega Cueto L,Aiello F,Day AC,Allan BD

doi

10.1016/j.ajo.2019.01.022

subject

Has Abstract

pub_date

2019-05-01 00:00:00

pages

54-62

eissn

0002-9394

issn

1879-1891

pii

S0002-9394(19)30043-1

journal_volume

201

pub_type

杂志文章

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