Long-Term Outcomes of Deep Anterior Lamellar Keratoplasty in Pediatric Keratoconus: A 15-Year Retrospective Analysis.

IF 2.1 3区医学 Q2 OPHTHALMOLOGY

Cornea Pub Date : 2025-09-05 DOI:10.1097/ICO.0000000000003993

Revathi Rajaraman, Venugopal Anitha, Arjun Velayudhan, Pinkal Shiroya, Anita Raghavan, Iswarya Mani, Mohammed Uduman Siddique

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引用次数: 0

Abstract

Purpose: To evaluate the long-term visual, functional outcomes, and complications associated with Deep Anterior Lamellar Keratoplasty (DALK) in pediatric keratoconus (KC).

Methods: A retrospective analysis of children aged ≤18 years who underwent DALK for KC between February 2006 and April 2021. Data on preoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal topography, surgical technique, and complications. The big bubble technique was preferred, with manual or hydrodissection used when necessary. Outcome measures included postoperative UCVA, BCVA, manifest refraction, epithelial healing time, and complications.

Results: A total of 348 eyes from 303 children (mean age of 14.62 ± 2.59 years) were analyzed. Preoperative corneal scarring was observed in 24.4%, and 27.9% had vernal keratoconjunctivitis. Big bubble technique was successful in 69.8% of eyes. Descemet membrane microperforation occurred in 38 cases (10.9%), and intracameral air tamponade was required in 29 eyes (48.3%). The mean epithelial healing time was 5.00 ± 6.09 days. Postoperatively, mean spherical correction improved from -8.43 ± 5.52D to -2.42 ± 2.60D, and mean refractive astigmatism from -4.65 ± 1.62D to -2.60 ± 1.87D. The UCVA improved from 1.26 ± 0.27 to 0.76 ± 0.32 Log MAR and BCVA from 0.64 ± 0.31 to 0.18 ± 0.17 Log MAR. Complications included graft vascularization in 14.7%, graft infections 6.9%, and glaucoma in 26.7.

Conclusions: DALK is a safe and effective procedure for managing pediatric KC, offering significant improvements in visual outcomes and refractive parameters with excellent graft survival rates over the long term.

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儿童圆锥角膜深前板层角膜移植术的远期疗效：15年回顾性分析。

目的：评价深前板层角膜移植术（DALK）治疗儿童圆锥角膜（KC）的长期视力、功能和并发症。方法：回顾性分析2006年2月至2021年4月期间因KC接受DALK治疗的≤18岁儿童。术前未矫正视力（UCVA）、最佳矫正视力（BCVA）、角膜地形图、手术技术和并发症的数据。首选大气泡技术，必要时使用人工或水力解剖。结果测量包括术后UCVA、BCVA、明显屈光、上皮愈合时间和并发症。结果：共分析303例患儿348只眼，平均年龄14.62±2.59岁。术前角膜瘢痕形成占24.4%，春性角膜结膜炎占27.9%。大泡技术的成功率为69.8%。网膜微穿孔38例（10.9%），内窥镜内空气填塞29例（48.3%）。平均上皮愈合时间为5.00±6.09 d。术后平均球面校正由-8.43±5.52 2d改善至-2.42±2.60D，平均屈光像散由-4.65±1.62 2d改善至-2.60±1.87D。UCVA从1.26±0.27 Log MAR改善到0.76±0.32 Log MAR， BCVA从0.64±0.31 Log MAR改善到0.18±0.17 Log MAR。并发症包括移植物血管化14.7%，移植物感染6.9%，青光眼26.7%。结论：DALK是一种安全有效的治疗儿童KC的手术，可显著改善视力和屈光参数，并具有良好的长期移植物存活率。

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.