Derin Anterior Lameller Keratoplasti Sonuçlarımız

Year 2021, Volume: 7 Issue: 3, 366 - 371, 01.09.2021

Aslı Çetinkaya Yaprak Mustafa Ünal

https://doi.org/10.53394/akd.979398

Abstract

Giriş/Amaç:Sağlıklı endotele sahip gözlerde büyük hava kabarcığı tekniği ile uyguladığımız derin anterior lamellar keratoplasti (DALK) perioperatif komplikasyonları ve klinik sonuçlarını sunmayı amaçladık.
Gereç ve Yöntemler:Derin anterior lamellar keratoplasti uyguladığımız 105 hastanın 120 gözünün verileri retrospektif olarak incelendi. Preoperatif muayeneleri, operasyon verileri, intraoperatif ve postoperatif komplikasyonlar, ek girişimler ve görsel sonuçlar değerlendirildi.
Bulgular:Çalışmaya 54 (%51,5) kadın, 51 (%48,5) erkek hasta dahil edildi. Ortalama yaş 30,9 ± 13,8 (12-75) idi. Preoperatif endikasyonlar keratokonus 80 (%66,7), korneal distrofi 20 (%16,7) göz, travmatik yüzeyel nefelyon 8 (%6,7), postherpetik keratit 6 (%5), kimyasal yanık 2 (%1,6), Salzmann nodüler dejenerasyonu 1 (%0,8) ve nonspesifik korneal opasite 3 (%2,5) gözde mevcuttu. 96 (%80) gözde büyük hava kabarcığı tekniği ile Descement membranı ayrıştırıldı. 4 (%3,3) gözde aşamalı manuel diseksiyon yapıldı. Postoperatif düzeltilmiş en iyi görme keskinliği 5/10 ve üzerinde toplam 29 göz mevcuttu. Hastaların ölçülebilen gözlerde sferik ve keratometrik astigmatizma değerleri sırasıyla -2,50 ± 2,25 ve –2,50 ± 2,25 idi. İki hastada stromal greft reddi izlendi ve medikal tedaviyle düzeldi. Dört hastada postoperatif glokom gelişti ve bir hastaya trabekülektomi uygulandı.
Sonuç:Sağlıklı endotele sahip olgularda büyük hava kabarcığı tekniği ile DALK cerrahisi etkili bir yöntemdir. Görsel ve refraktif sonuçları standart yöntem olan penetran keratoplasti ile benzerdir, endotelyal greft reddi riskini ortadan kaldırması çok büyük bir avantaj sağlamaktadır.

Keywords

Büyük hava kabarcığı tekniği, Derin anterior lameller keratoplasti, Greft ömrü

Outcomes in Patients Who Underwent Deep Anterior Lamellar Keratoplasty

Abstract

Objective:To report the perioperative complications and clinical outcomes after deep anterior lamellar keratoplasty (DALK) using the big bubble technique in eyes with healthy endothelium.
Methods:This retrospective, interventional case series demonstrated the data of 120 eyes in 105 patients who underwent DALK. Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were analyzed.
Results:The study included 54 (51.5%) females and 51 (48.5%) males patients. Mean age was 30.9 ± 13.8 (12-75) years. Preoperative indications were keratoconus in 80 (66.7%), corneal dystrophy in 20 (16.7%), traumatic corneal scar in 8 (6.7%), postherpetic keratitis 6 (5%), chemical burn 2 (1.6%), Salzmann nodular degeneration 1 (0.8%) and nonspecific corneal opacity 3 (2.5%) eyes. Complete Descemet membrane exposure via big bubble could be achieved in 96 cases (80%). Four (3.3%) required layer-by-layer manual dissection. A total of 20 (16.7%) were converted to penetrating keratoplasty (PK) intraoperatively. Best spectacle–corrected visual acuity of 5/10 or better was present in 29 eyes postoperatively. The mean spherical equivalent and topographic astigmatism were –2.50 ± 2.25 and –2.50 ± 2.25 diopter, respectively. There were two instances of stromal graft rejection, which responded to medical therapy. Postoperative glaucoma diagnosed in four eyes and one of them necessitated trabeculectomy.
Conclusion:DALK big-bubble technique may be a valuable and an effective procedure in the treatment of patients with healthy endothelium. The visual and refractive outcomes are comparable to standard penetrating keratoplasty, avoiding the risk of endothelial rejection.

Keywords

Big-bubble technique, Deep anterior lamellar keratoplasty, Graft survey

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