| Objective:To evaluate the clinical effections of full-bed deep lamellar keratoplasty(FB-DLKP)which was performed using Yao's hooking-detaching technique,and analyze the difference of some indexes before and after FB-DLKP which include uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),corneal thickness,endothelial cell counts(ECC),astigmatism,situation of operation and postoperative complications in treating keratoconus which on different stages.Methods:the study included retrospectively 53 patients,56 eyes who was diagonosed with keratoconus and recived the FB-DLKP and at least one year of complete follow-up in ophthalmology department of Sir Run Run Shaw Hospital from January 2013 to December 2015.According to Amslere-Krumeich Keratoconus Classification Stage,we divide the paitents into 2 groups,group A represents ? stage and ? stage,group B represents ? stage.To evaluate UCVA,BCV A,comeal thickness,ECC,astigmatism,situation of operation,postoperative complications and so on,before FB-DLKP and 1st,6th,12th month after FB-DLKP on different stages.Using the median[25%,75%]to represent abnormal distribution data,and the averages±standrd deviation to represent the normal distribution data.Using non-parametric test to make statistical analysis for abnormal distribution data,and using t-test to make statistical analysis for normal distribution data.Results:There are 53 patients and 56 eyes being included the study.And there are 35 males,18 females,and 26 left eyes,30 right eyes in these objects of study.The range of these patients is between 14 and 41 years old,average age is 22.68±7.17.There 18 eyes which one II and III stage(group A),38 eyes on IV stage(group B).After evaluating UCVA,BCVA,corneal thickness,ECC,situation of operation,postoperative complications and the results as following:there were 3 eyes(5.4%)in actue cornal scarring of keraoconus,but the sacrs didn't split again during the operation.There were 2 eyes(3.6%)which occurred some microperforations in descemet membrane during operation,and gave air injection to the antherior chamber.In A group,the median[25%,75%]of UCVA(standardized logMAR visual acuity)of lst,6th,12th month after opetation are 0.75[0.54,0.90].0.56[0.34,0.82].0.52[0.40,0.67](Wilcoxon symbols test,P<0.05).In B group are 0.56[0.40,0.90].0.52[0.40,0.60].0.40[0.22,0.60](Wilcoxon symbols test,P<0.05).And there is no significant difference between group A and group B about UCVA.In A group,the median[25%,75%]of BCVA of lst,6th,12th month after opetation are 0.34[0.24,0.40].0.26[0.22,0.40]?0.26[0.11,0.35](Wilcoxon symbols test,P<0.05).In B group are 0.26[0.22,0.40].0.22[0.15,0.30]?0.22[0.11,0.28](Wilcoxon symbols test,P<0.05).But there are no statistical differences between group A and B about BCVA after FB-DLKP(Rank Sum Test,P>0.05).In group A and B,the median[25%,75%]of corneal thickness which before FB-DLKP are 411[360,436]?m 357[319.75,371](Rank Sum Test,P<0.05)and in group A,the corneal thickness of 1st,6th,12th month after FB-DLKP are 515[498.25,531.25]?m?467[458.5,493.25]?m?464[445.75?471]pm(Wilcoxon symbols test,P<0.05).In group B are 539.5[515.5,566.5]?m?479.5[458.25,503.75]?m?467[449,504.75]?m(Wilcoxon symbols test,P<0.05).But there are no statistical differences between group A and B about corneal thickness after FB-DLKP(Rank Sum Test,P>0.05).In group A and B,the median[25%,75%]of ECC which before FB-DLKP are 2322[2287,2587]cells/mm~2?2516.5[2326.50,2612.25]cells/mm~2,(Rank Sum Test,P>0.05),In group A,the ECC of 1st 6th,12th month after FB-DLKP are 2224.5[2013,2314.5]cells/mm~2?2253.5[2070.25,2311.5]cells/mm~2?2210[1850.5,2288.5]cells/mm~2,there is statistical difference between 6th and 12th,(Wilcoxon symbols test,P<0.05),but there is no statistical difference between 1st and 6th(Wilcoxon symbols test,P>0.05).In group B are 2217[2013.5,2374]cells/mm~2?2166.5[1990,2311.5]cells/mm~2,2084.5[1870,2259]cells/mm~2(Wilcoxon symbols test,P<0.05).But there are no statistical differences between group A and B about ECC after FB-DLKP(Rank Sum Test,P>0.05).In group A and B,the median[25%,75%]of astigmatism before FB-DLKP are 4.33[3.12,5.87]D.8.21[4.50,12.01]D(Rank Sum Test,P<0.05).In group A,the astigmatism of 6th and 12th month after FB-DLKP are 5.16[2.76,9.67]D?3.67[3.06,6.13]D(Wilcoxon symbols test,P<0.05),In group B are 5.21[3.61,7.44]D?3.71[1.99,5.21]D(Wilcoxon symbols test,P<0.05),but there are no statistical differences between group A and B about astigmatism after FB-DLKP(Rank Sum Test,P>0.05).On different stages,the survival rate of corneal craft is 100%.There are no high intraocular pressure(IOP),secondary glaucoma,complicated cataract and only one eye(1.8%group B)had wound dehiscence on first postoperative day.Conclusion:The keratoconus on different stages which afer the FB-DLKP,no matter what,the UCVA and BCVA were both better than preoperative.Although the ECC after FB-DLKP which on different stages were less than preoperative,after a long term follw-up,the remaining endothelial cells could still keep the cornea clear.The coneal thickness which on different stages was also more thick than preoperative,and after a long term follw-up coneal thickness could keep stesdy.The astigmatism after FB-DLKP which on different stages was also less than preoperative.The incidence of postoperative complications such as secondary glaucoma,complicated cataract and wound dehiscence were very low which the patients on different stages before FB-DLKP.Comparing group A and B,we can find out that although the coneal thickness,astigmatism and corneal curvature of ? stage are worse than ? and ? stage before operation,the each follow-up index can get the same effections both group A and group B after FB-DLKP.There is no rejection is the greatest advantage of FB-DLKP.The patient with FB-DLKP needn't use anti-rejection drugs whole life.Becaue FB-DLKP don't need fresh cornea,donor's source can be enlarged.So the FB-DLKP is one of the best treatment methods in treating keratoconus nowdays. |
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