| Objective: To review the patients with keratoconus who were admitted to our hospital for surgical treatment in the past 20 years,to observe and statistics the related prognostic indexes,to compare and analyze the prognosis of keratoconus patients in acute edema stage and full-thickness scar stage,and to evaluate whether DALK surgery can be an effective alternative to PKP surgery.Methods: A total of 45 patients(45 eyes)with edema keratoconus and scar keratoconus were enrolled in our ophthalmology department from 2000 to 2022,including scar group(26 eyes).Penetrating keratoplasty(7 eyes)and deep lamellar keratoplasty(19 eyes),edema group(19 eyes),penetrating keratoplasty(12 eyes)and deep lamellar keratoplasty(7 eyes).The follow-up period was more than 1 year.The uncorrected visual acuity,best corrected visual acuity,astigmatism,equivalent spherical lens,corneal endothelial cell density,postoperative complications and graft survival were observed 1,6,12 months after operation and every year after operation.Results: Postoperative best corrected visual acuity(Log MAR): at 1 month,6 months and12 months after operation,the average BCVA of scar group(0.431 ±0.1995,0.392 ±0.1623,0.238 ±0.1235,respectively),edema group(0.374 ±0.2023,0.368 ±0.1945,0.232 ±0.1204),there was no significant difference(P>0.05).At 1 and 6 months after operation,the average BCVA of PKPa group(0.371 ±0.2812,0.357 ±0.2225)and DALKb group(0.453±0.1645,0.405 ±0.1393)had no significant difference.At 12 months after operation,there was no significant difference in BCVA between PKPa group and DALKb group(0.257±0.1512)and(0.232 ±0.1157)respectively.At 1 and 6 months after operation,there was no significant difference in the average BCVA of PKPc group(0.383 ±0.2250,0.375±0.2137)and DALKd group(0.357 ±0.1718,0.357 ±0.1718).At 12 months after operation,there was no significant difference in BCVA between PKPc group and DALKd group(0.217 ±0.1337)and(0.257 ±0.976)respectively.Postoperative astigmatism: 1 month,6months and 12 months after operation,the astigmatism value of scar group(3.5577±0.67568,3.3558 ±0.66398,3.0481 ±0.69289)was significantly lower than that of edema group(4.2763 ±0.57066,4.0132 ±0.59788,3.6053 ±0.54846).There was no significant difference between the scar group and the edema group.One month after operation,the equivalent spherical lens in scar group(2.6346 ±0.73902)and edema group(3.0263±0.60032)had no statistical significance.At 6 and 12 months after operation,the equivalent spherical lens in the scar group(2.6250 ±0.67546,2.4423 ±0.72907)was significantly lower than that in the edema group(3.4079 ±0.63580,3.1711 ±0.58957).Six months after operation,the postoperative equivalent spherical lens in PKPa group(3.0357±0.41904)was significantly higher than that in DALKb group(2.4474 ±0.66447).At 1 and12 months,there was no significant difference between subgroups in scar group.There was no significant difference among the subgroups in the edema group.The average rate of endothelial cell loss at 6 and 12 months after operation compared with 1 month after operation: scar group(5.58 ±2.70%,10.92 ±4.94% respectively),edema group(7.25±3.42%,14.40 ±5.80% respectively),the difference was not statistically significant(P >0.05).In the scar group,the PKPa group(9.56 ±1.42%,18.55 ±1.48%,respectively)was significantly higher than the DALKb group(4.12 ±1.02%,8.11 ±1.50%,respectively),and the difference was statistically significant(P < 0.001).The difference in the edema group(9.37 ±2.31%,18.34 ±2.90%)was significantly higher than that in the DALKd group(3.63±1.06%,7.59 ±0.33%,respectively),and the difference was statistically significant(P <0.001).In terms of complications: intraoperative complications occurred in both scar group(3.85%)and edema group(10.52%).One case of posterior elastic layer microperforation appeared in DALKb,1 and one case of endothelial perforation appeared in DALKd group.Postoperative complications: the incidence of secondary shallow anterior chamber,double anterior chamber,high intraocular pressure,secondary glaucoma,secondary cataract,transplant rejection in scar group was 7.69%,11.54%,15.38%,0,3.85%,15.38%.The incidence in edema group was 10.52%,10.52%,26.32%,10.52%,5.26%,21.05%.Up to the last follow-up,only one patient(DALKb group)failed because of repulsive reaction and recovered well after penetrating keratoplasty.The results of Kaplan-Meier survival analysis and log-rank test showed that there was no significant difference in visual prognosis between scar group and edema group.Conclusion: Keratoplasty can be used to treat patients in both edema stage and scar stage of keratoconus.There is no need to use other means to wait for patients to enter the scar stage and then perform keratoplasty.DALK can become an effective alternative to PKP surgery to treat patients in scar stage of keratoconus. |
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