| Purpose:Evaluating the curative effect of full-bed deep lamellar keratoplasty (FBDLK) in keratoconus patients with or without hydrops; analyzing their differences in various indicators after FBDLK; evaluating the history of acute corneal hydrops’ influence on operation process, postoperative complications, visual acuity, corneal endothelial density and corneal thickness.Study design:Retrospective studiesData and methods:From April2011to March2014, there were108cases (131eyes) of keratoconus patients underwent FBDLK in our hospital, among which19cases (19eyes) of keratoconus patients with history of acute corneal hydrops were included in hydrops group.19cases (19eyes) of keratoconus patients without corneal hydrops were randomly selected, forming the control group. The subsiding process of corneal hydrops is observed; the operation process and the postoperative complications are also observed. The preoperative visual acuity, corneal endothelial density and corneal thickness and these indicators at follow-up visits after the operation for1day,1month,6months and12months are recorded and analyzed.Results:Hydrops group and control group have no significant difference in the general conditions.100%of patients in hydrops group bear scars, and all the Descemet’s membranes are involved;36.8%of patients in control group bear scars mostly on the middle and anterior layer of corneal stroma, and all of their DMs are clear.For hydrops group, the time interval between the occurrence of acute corneal hydrops and the beginning of vision impairment is5.21±4.25years. Among the hydrops group9patients visited our hospital for treatment immediately after the occurrence of hydrops, their cornea thickness in acute hydrops period is1325.11±345.69μm, cornea thickness after the subsiding of hydrops is454.56±96.45μm, time for the hydrops to subside is107.89±25.72days, the size of broken area of DM is1.96±2.46mm2, distance between DM and corneal stroma is321.1±240.58μm. For the hydrops group and control group, their intraoperative perforation rates are78.95%,0%; the rate of anterior chamber air injection are63.16%,0%; the rate of converted penetrating keratoplasty are0%,0%; the operation time are72.00±12.15and64.74±14.48minutes, respectively. Besides, the rate of postoperative double anterior chamber are10.53%,0%, ocular hypertension:5.26%,10.53%, secondary glaucoma:5.26%,0%, rejection reaction:0%,0%, transportation failure:0%,0%.The visual acuity of these two groups befor the operation and after it for1day,1month,6months and12months are recorded. For the hydrops group are0.075±0.084,0.086±0.087,0.198±0.115,0.275±0.215,0.396±0.189; and for the control group are0.088±0.07,0.209±0.174,0.269±0.171,0.299±0.140,0.361±0.178. The best corrected visual acuity at these time points are:hydrops group:0.154±0.118,0.086±0.087,0.335±0.174,0.505±0.207,0.563±0.199; control group:0.291±0.217,0.209±0.174,0.472±0.193,0.575±0.191,0.607±0.139.Corneal endothelial density of the two groups befor the operation and after it for1month,6months and12months are recorded, for the hydrops group are2397±454cells/mm2,1335±533cells/mm2,1434±432cells/mm2,1437±465cells/mm2; for the control group are2613±303cells/mm2,2276±286cells/mm2,2186±241cells/mm2,2198±234cells/mm2. Endothelial cells loss rate of these two groups for1month,6months,12months after the operation are:hydrops group:45.2±29.1%,39.2±17.5%,35.3±34.5%; control group:11.4±12.0%,16.0±12.0%,15.0±9.1%.Corneal thickness of these two groups befor the operation and after it for1day,1month,6months and12months are also recorded. For the hydrops group are459.00±86.85μm,828.00±138.28pm,611.23±97.98μm,528.18±61.38μm,509.67±38.45μm; for control group are416.07±63.07μm,618.92±65.39μm,546.38±47.85μm,497.94±38.85μm,487.73±24.70μm. Conclusion:The short-term visual acuity of keratoconus patients with acute corneal hydrops after FBDLK is lower than that of patients without hydrops, but both groups can achieve a similar long-term visual acuity. The loss of endothelial cell of patients with hydrops before is more than that of patients without hydrops, but the number of endothelial cells is stable, the remaining endothelial cell can still maintain the transparency of the cornea. The graft hydrops of patients with hydrops before in short term is heavier than that of patients without hydrops, but both groups have similar long-term corneal thickness. Considering that the occurrence of acute corneal hydrops has little influence on long-term visual acuity and graft hydrops, the number of endothelial cells after FBDLK is stable, the application of FBDLK surgery on keratoconus patients with acute corneal hydrops is feasible and worth promoting. |
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