| Purpose:To report a acute and therapeutic surgical technique and the surgical outcomes of Deep anterior lamellar keratoplasty with partial penetrating(PP-DALK)for severe infectious corneal ulcer during COVID-19 crisis.Method:In 2020,23 patients(eyes)who received acute and therapeutic PP-DAL K in our department were retrospectively studied,including 14 males and 9 femakes,with the mean age of 58.4±15.0(23～82)years old.And the mean diameter of cor neal ulcer was 6.674±1.202(5～9)mm,the mean diameter of corneal perforation w as 2.630±0.772(2～5)mm.Patients were divided into two groups according to the c orneal grafts used in the surgery,including 11 eyes in the bioengineered cornea group and 12 eyes in the glycerine cryopreserved human cornea group.All patients were f ollowed up for 6months.Main outcome measures included the primary control rate,oc ular anatomic integrity,and Secondary outcome measures included the time of re-epit helialization,orneal complications and best visual acuity 、corneal transparency、 corn eal neovascularization during the follow-up at 3days,7days,1 month,3months,6months a nd the last follow-up were observed.SPSS26.0 statistical software was used to analy ze the statistics.P<0.05 was considered statistically significant.Results:The primary disease of 21 eyes was controlled and the anatomy integrity was preserved,and there was no significant difference between the two groups(P=0.949).The time of re-epithelialization between the bioengineered cornea group and th e glycerine cryopreserved human cornea group was 7.4±3.239days/6.45±3.012 days.And there was no significant difference between the two groups(P=0.426).The mean BCVA in bioengineered cornea group(2.85±0.76、2.85±0.76、2.77±0.90、2.52±0.85、2.50±0.90、2.50±0.90)Log MAR were no significant difference with that in the glycerine cryopreserved human cornea group(2.95±0.65、2.95±0.65、2.93±0.51、2.48±0.77、1.83±0.75、1.83±0.75)at 3 days,7days,1 month,3months,6months and the last follow-up(all p value>0.05,0.756、0.756、0.705、0.654、0.061、0.06).The graft transparency had a significant difference between the two groups at 7days after oper ation(all p value<0.05,0.006、0.036、0.01、0.029、0.029),and 3 months after surge ry there was significant difference in corneal neovascularization between the two grou ps(all p value<0.05,0.003、0.001、0.001),The central corneal thickness in 3 an d 6 months after surgery was 1029.00±64.45(978-1205)μm and 972.50±62.21(867～996)μm in the bioengineered cornea group,respectively.Glycerine cryopreserve d human cornea group: 1025.91±52.98(977-1107)μm,921.00±49.20(867-996)μm,t here was no statistical difference between the two groups(P=0.468;P = 0.072).Posto perative complications occurred in 7 patients and timely treatment was controlled.Conclusions: In the period of COVID-19 crisis,PP-DALK can suppress inflammat ory responses,the structure of the eyeball was preserved intact in the treatment of p atients with severe infectious corneal ulcer.And there is almost no difference betwee n bioengineered cornea and glycerine cryopreserved human cornea.in clinical efficacy during the follow-up.The use of glycerol-preserved corneas or bioengineered corneas for PP-DALK has allowed eye banks to utilize nonviable tissue for emergency surg ery in situations in which fresh donor corneas are not available. |
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