| Purpose:The current study is to analyse the pre- and postoperative difference in terms of uncorrected visual acuity(UCVA), best-corrected visual acuity(BCVA), corneal astigmatism and corneal thickness, etc and to contrast postoperative visual outcomes between partial lamellar keratoplasty group and full lamellar keratoplasty group so as to further assess the therapeutic effects of lamellar keratoplasty treatment in the management of corneal Terrien’s marginal degeneration.Methods:Patients with Terrien’s marginal degeneration treated by lamellar keratoplasty were recruited from Qingdao Eye Hospital of Shandong Eye Institute between Dec. 1995 and Mar. 2014. Examinations including visual acuity, corneal astigmatism, corneal thickness and corneal endothelial density, etc were performed preoperatively. All patients were underwent lamellar keratoplasty by a single surgeon under peribulbar anesthesia. Surgical types were mainly determined by the lesion scope and the residual corneal thickness, with 56 eyes in the partial lamellar keratoplasty group and 15 eyes in the full lamellar keratoplasty group.According to whether suffered from obvious irritation symptom, all cases were divided into two categories: inflammatory group(30 cases)and non-inflammatory(33 cases).The patients were evaluated daily for the first week after surgery, weekly within 3 months, and every 2 or 3 months thereafter.Data of visual outcomes, graft status and complications were collectedand statistically analyzed with SPSS software(version 19.0).Results:1. Patient information: A total of 63 patients(71eyes) underwent lamellar keratoplasty during the study period(28 males and 35 females). Mean age at the time of surgery was(50.35±16.78) years. The average course of disease was(11.00±3.54) years and mean follow-up period was(2.40±0.93) years. In our study, 33(52.38%) cases were non-inflammatory and they only presented with a history of progressive visual loss, without any ocular irritation symptoms. Others would appear to be the inflammatory type, their chief complaint was diminution of vision with obvious ocular pain, photophobia, tearing, foreign body sensation, etc. There was no significant difference between patients with and without inflammation in terms of the perforation rate and age of onset( =0.002,p =0.964; t =-1.271,p =0.209). 2x2. Lesion characteristics: The corneal lesion location of superonasal, superotemporal, inferonasal, inferotemporal quadrant were involved in 85.92%, 56.34%, 35.21% and 25.35% of cases, respectively. Most lesions were arc-like, and the width was about 1.5mm-3mm. 44 patients were examined by AS-OCT for the thickness of the thinned cornea, and the mean corneal thickness was(310.75±75.43) μm. All eyes had corneal thinning, of which descemetocele developed in 19 eyes(26.76%), and perforation in 9 eyes(12.68%). Among patients with descemetocele, the average corneal thickness was(179.57±47.40)μm.Corneal perforation occurred in 9 eyes, one eye suffered slight ocular trauma and others had no specific precipitating factors. The perforation patients were younger(39.00±22.86 years) compared with non-perforation patients(51.71±15.13 years;t=-2.091,p=0.04), but the sex ratio was comparable between the two cases( =0.484,p =0.487). 2x3. Visual outcome and graft status: A total of 71 eyes were included in the evaluation, with 56 eyes in the partial lamellar keratoplasty group and 15 eyes in the full lamellar keratoplasty group. After lamellar keratoplasty, the uncorrected visual acuity(UCVA) was improved from(0.83±0.38) logarithm of the minimum angle of resolution(log MAR) to(0.35±0.18) log MAR(t =-7.304, p =0.000), and there was statistical significance between the two groups(t=-4.085, p=0.001). Before operation, the best-corrected visual acuity was(0.22 ± 0.09) log MAR, and remained in the same level postoperatively(t=0.379, p=0.711).Spherical equivalent was reduced significantly from preoperative(-2.23±2.34) D to postoperative(-0.75±2.04) D,(t =-2.677, p =0.012). Slit lamp examination showed mild stromal edema during the first 2 days after surgery and the edema subsidized spontaneously thereafter. No obvious diminution of corneal endothelial density was found during the follow-up period(t=1.105,p=0.301).Postoperatively,graft epithelium defects occurred in 4 eyes, three of which the epithelia was healed after drug and corneal contact lens treatment, and another eye suffered blepharorrhaphy. 4. Intra- and postoperative complications: Main complication encountered during operation was corneal perforation(7.04%), and postoperative complications included hydrops between graft and recipient interface(11.27%), corneal vascularization(4.23%), graft ulcers(2.82%) and recurrence of marginal degeneration(2.82%).Conclusions:This study produced evidence supporting the notion that therapeutic LK appears to be effective in the treatment of TMD. This approach can not only eradicate degeneration lesions and restore ocular structure but can also reduce corneal astigmatism and achieve satisfactory visual acuities. |
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