Investigation of the therapeutic effects on patients with high-risk corneal transplantation by double lamellar keratoplasty

Abstract

Objective To investigate the therapeutic effects of double lamellar keratoplasty (DLK) on patients with high-risk corneal transplantation.Methods A retrospective case series study.The study was made in 25 successional patients who had high-risk corneal transplantation in the Second Affiliated Hospital of Nanhua University from January 2008 to June 2012 (10 males and 7 females).Eight of whom accepted with DLK (5 males and 3 females),and 17 patients with penetrating keratoplasty (PKP) (10 males and 7 females).Visual acuity,best corrected visual acuity (BCVA),intraocular pressure,slit lamp examination,fundus examination and corneal endothelial cell density were checked in postoperative 1,3,6,and 12 months.Visual acuity preoperative between the two groups was compared using Kruskal-Wallis H test.The rate of rejection between the two groups was compared using Fisher's exact probability.Mean values for each experiment were compared between the two groups using LSD-t test.Results There were no significant difference (P ＞0.05) between DLK and PKP in the average age (43.6±6.5 v.s.45.3±15.7) and preoperative vision (FC/20cm～0.1 v.s.FC/20cm～0.08).The visual acuity of DLK group were better than PKP group in postoperative 1,3,6,and 12 months (P ＜0.05).The BCVA of DLK group were better than PKP group 12months after surgery (P ＜0.05).The corneal endothelial cell densities of two groups were decreased gradually.The corneal endothelial cell density of DLK group was higher than PKP group (P ＜0.05)during the review.There was no secondary glaucoma in DLK group,while 2 cases of PKP group appeared secondary glaucoma in a month after operation.In one year,there was no significant difference about the rate of rejection between the two groups (2 cases in DLK,25％ v.s.6 cases in PKP,35.3％).After anti-rejection treatment,2 patients of DLK group were controlled,and cornea graft restored to transparency.However,4 grafts in PKP group got back to clearly,the other 2 cases were still opacity.Conclusions DLK for corneal transplantation in high-risk eyes has a better BCVA,less endothelial cell lose,and probable lower incidence of rejection compared with PKR. Key words: High-risk corneal transplantation; Double lamellar keratoplasty; Penetrating keratoplasty; Effect