Impact of Intraoperative Descemet Membrane Perforation on Survival in Deep Anterior Lamellar Keratoplasty for Keratoconus.

IF 2.1 3区医学 Q2 OPHTHALMOLOGY

Cornea Pub Date : 2025-08-20 DOI:10.1097/ICO.0000000000003974

Hiroto Mitamura, Masaki Fukui, Akiko Ogawa, Yukari Yagi-Yaguchi, Daisuke Tomida, Masatoshi Hirayama, Takefumi Yamaguchi, Jun Shimazaki

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引用次数: 0

Abstract

Purpose: To investigate the influence of perforation of Descemet membrane (DM) on graft survival outcomes during deep anterior lamellar keratoplasty (DALK) for treating keratoconus.

Methods: We retrospectively reviewed 81 eyes of 77 patients with keratoconus who underwent deep anterior lamellar keratoplasty (DALK). Graft survival, best spectacle-corrected visual acuity (BSCVA), corneal endothelial cell density, and postoperative complications were compared between eyes with and without intraoperative Descemet membrane (DM) perforations.

Results: The overall rate of clear grafts was 91.4% 5 years after the operation. Intraoperative DM perforations occurred in 44% of the eyes. Graft survival at 5 years did not differ significantly between eyes with (86.1%) and without (95.6%) DM perforation ( P = 0.345). The incidence of double anterior chamber (DAC) was significantly higher in eyes with DM perforation (30.5%) than in eyes without DM perforation (11.1%) ( P = 0.048). Postoperative DAC was significantly associated with graft failure ( P = 0.013), and the 4 groups, with or without DM perforation and with or without DAC ( P = 0.035), differed significantly in graft failure. Visual acuity improved significantly after DALK in comparison with the preoperative BSCVA in eyes with and without DM perforation at all observation periods in both groups ( P < 0.0001). The BSCVA did not significantly differ between the 2 groups, except at 3 months after DALK ( P = 0.045).

Conclusions: Intraoperative DM perforation has no negative impact on the long-term prognosis of patients with advanced keratoconus.

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术中网膜穿孔对圆锥角膜深前板层角膜移植术存活的影响。

目的：探讨深前板层角膜移植术（DALK）治疗圆锥角膜时，角膜下膜穿孔（DM）对移植物存活的影响。方法：对77例圆锥角膜行深前板层角膜移植术的81眼患者进行回顾性分析。比较术中有和无DM穿孔眼的移植成活率、最佳眼镜矫正视力（BSCVA）、角膜内皮细胞密度和术后并发症。结果：术后5年移植物通透率为91.4%。术中DM穿孔发生率为44%。有（86.1%）和无（95.6%）DM穿孔的眼5年移植物存活率无显著差异（P = 0.345）。双前房（DAC）发生率在DM穿孔组（30.5%）显著高于无DM穿孔组（11.1%）（P = 0.048）。术后DAC与移植物衰竭显著相关（P = 0.013），有无DM穿孔、有无DAC组移植物衰竭差异有统计学意义（P = 0.035）。两组有及无DM穿孔眼在所有观察期内，DALK术后视力均较术前BSCVA有显著改善（P < 0.0001）。除DALK后3个月外，两组间BSCVA无显著差异（P = 0.045）。结论：术中DM穿孔对晚期圆锥角膜患者的远期预后无不良影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cornea 医学-眼科学

CiteScore

5.20

自引率

10.70%

发文量

354

审稿时长

3-6 weeks

期刊介绍： For corneal specialists and for all general ophthalmologists with an interest in this exciting subspecialty, Cornea brings together the latest clinical and basic research on the cornea and the anterior segment of the eye. Each volume is peer-reviewed by Cornea''s board of world-renowned experts and fully indexed in archival format. Your subscription brings you the latest developments in your field and a growing library of valuable professional references. Sponsored by The Cornea Society which was founded as the Castroviejo Cornea Society in 1975.