AIM：To compare the functional and anatomic results of femtosecond laser（FSL）-assisted deep anterior lamellar keratoplasty（DALK） associated with phototherapeutic keratectomy（PTK） and FSL-assisted DALK performed ...AIM：To compare the functional and anatomic results of femtosecond laser（FSL）-assisted deep anterior lamellar keratoplasty（DALK） associated with phototherapeutic keratectomy（PTK） and FSL-assisted DALK performed using the big-bubble technique in keratoconus.METHODS：During the first phase of the study,an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups：in FSL group,FSL lamellar cuts were performed on two corneas and in FSL＋PTK group,PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made.During the second phase of the study,a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus：group 1（n=14 eyes） underwent FSL-assisted DALK associated with PTK and group 2（n=12 eyes） underwent FSL-assisted DALK associated with the bigbubble technique.The main outcome measures were the postoperative visual acuity（VA） and optical coherence tomography（OCT） measurements,confocal microscopic findings,and contrast sensitivity.RESULTS：In the pilot study,histopathology showed a more regular stromal bed in the FSL＋PTK group.In the clinical trial,group 1 had significantly worse best spectaclecorrected VA and contrast sensitivity（P〈0.05 for both comparisons）.The residual stromal bed measured by OCT was significantly（P〈0.05） thicker in group 1.Confocal microscopy detected opacities only at the donor-receptor interface in group 1.CONCLUSION：Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.展开更多
AIM: To compare and evaluate the clinical outcomes of deep anterior lamellar keratoplasty(DALK) and excimer laser assisted anterior lamellar keratoplasty(ELLK) in eyes with keratoconus.METHODS: In this study, 57 eyes ...AIM: To compare and evaluate the clinical outcomes of deep anterior lamellar keratoplasty(DALK) and excimer laser assisted anterior lamellar keratoplasty(ELLK) in eyes with keratoconus.METHODS: In this study, 57 eyes of 56 patients operated between 2013 to 2017 were included. Thirty-one eyes underwent big-bubble DALK and twenty-six eyes underwent ELLK. Preoperative and at control visits complete ophthalmic examination was performed. RESULTS: The mean patient age at the time of DALK surgery was 27 y and mean follow-up period was 21±5.4 mo. The mean patient age at the time of ELLK surgery was 27 y and mean follow-up period was 40±18 mo. Mean best spectacle corrected visual acuity(BSCVA) at postoperative period was significantly higher for DALK group(0.66±0.11) versus ELLK group(0.4±0.2)(P<0.05). Descemet's membrane microperforation was occurred in 7 patients in DALK group versus in 1 patient in ELLK group. In 4 eyes, interface irregularity was developed in ELLK group. None of the patients in follow-up had graft rejection in both groups.CONCLUSION: In ELLK group, complication rate is lower, the surgical technique is simpler, faster and safer and also ELLK requires less experience with respect to DALK. Further, DALK can be performed unless satisfactory visual acuity is achieved after ELLK.展开更多
文摘AIM：To compare the functional and anatomic results of femtosecond laser（FSL）-assisted deep anterior lamellar keratoplasty（DALK） associated with phototherapeutic keratectomy（PTK） and FSL-assisted DALK performed using the big-bubble technique in keratoconus.METHODS：During the first phase of the study,an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups：in FSL group,FSL lamellar cuts were performed on two corneas and in FSL＋PTK group,PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made.During the second phase of the study,a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus：group 1（n=14 eyes） underwent FSL-assisted DALK associated with PTK and group 2（n=12 eyes） underwent FSL-assisted DALK associated with the bigbubble technique.The main outcome measures were the postoperative visual acuity（VA） and optical coherence tomography（OCT） measurements,confocal microscopic findings,and contrast sensitivity.RESULTS：In the pilot study,histopathology showed a more regular stromal bed in the FSL＋PTK group.In the clinical trial,group 1 had significantly worse best spectaclecorrected VA and contrast sensitivity（P〈0.05 for both comparisons）.The residual stromal bed measured by OCT was significantly（P〈0.05） thicker in group 1.Confocal microscopy detected opacities only at the donor-receptor interface in group 1.CONCLUSION：Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.
文摘AIM: To compare and evaluate the clinical outcomes of deep anterior lamellar keratoplasty(DALK) and excimer laser assisted anterior lamellar keratoplasty(ELLK) in eyes with keratoconus.METHODS: In this study, 57 eyes of 56 patients operated between 2013 to 2017 were included. Thirty-one eyes underwent big-bubble DALK and twenty-six eyes underwent ELLK. Preoperative and at control visits complete ophthalmic examination was performed. RESULTS: The mean patient age at the time of DALK surgery was 27 y and mean follow-up period was 21±5.4 mo. The mean patient age at the time of ELLK surgery was 27 y and mean follow-up period was 40±18 mo. Mean best spectacle corrected visual acuity(BSCVA) at postoperative period was significantly higher for DALK group(0.66±0.11) versus ELLK group(0.4±0.2)(P<0.05). Descemet's membrane microperforation was occurred in 7 patients in DALK group versus in 1 patient in ELLK group. In 4 eyes, interface irregularity was developed in ELLK group. None of the patients in follow-up had graft rejection in both groups.CONCLUSION: In ELLK group, complication rate is lower, the surgical technique is simpler, faster and safer and also ELLK requires less experience with respect to DALK. Further, DALK can be performed unless satisfactory visual acuity is achieved after ELLK.
