Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Keratokonus Olgularında Penetran Keratoplasti ve Derin Anterior Lameller Keratoplasti CerrahilerininUzun Dönem Sonuçlarının Karşılaştırılması: Retrospektif Çalışma
Comparison of Long-Term Outcomes of Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty Surgery in Patients with Keratoconus: Retrospective Study
Burcu KEMER ATİKa , Ahmet KIRGIZa , Erdem ERDOĞDUa , Sibel AHMETa , Mehmet Özgür ÇUBUKa , Nilay KANDEMİR BEŞEKa
aSağlık Bilimleri Üniversitesi Beyoğlu Göz Eğitim ve Araştırma Hastanesi, Göz Hastalıkları ABD, İstanbul, Türkiye
Turkiye Klinikleri J Ophthalmol. 2023;32(2):113-21
doi: 10.5336/ophthal.2022-95149
Article Language: TR
Full Text
ÖZET
 Amaç: Keratokonus nedeniyle uygulanan penetran keratoplasti (PK) ve derin anterior lameller keratoplasti (DALK) cerrahilerinin uzun dönem sonuçlarını karşılaştırmaktır. Gereç ve Yöntemler: PK ve DALK geçiren keratokonus olgularının tıbbi kayıtları retrospektif olarak tarandı. Olguların ameliyat öncesi ve ameliyat sonrası 5. yılda elde edilen en iyi düzeltilmiş görme keskinliği (EİDGK) değerleri, sferik ve silindirik refraktif hata değerleri ile sferik eşdeğerleri kaydedildi. Takip süresi boyunca gelişen greft red reaksiyonları ve komplikasyonlar incelendi. Bulgular: Çalışmaya 64 olgunun 64 gözü dâhil edildi. Olgular ortalama 70,41±10,67 (60-96 arası) ay takip edildi. Olguların 33'üne PK, 31'ine DALK uygulandı. Her iki grupta da ameliyat sonrası 5. Yıl ortalama EİDGK değerleri, ameliyat öncesi değerlerden daha yüksek idi (her bir p değeri <0,001). PK uygulanan olguların ameliyat öncesi EİDGK değerleri DALK uygulanan olgulardan daha düşük iken (p=0,002); ameliyat sonrası 5. yıl 2 grubun EİDGK değerleri istatistiksel açıdan benzerdi (p=0,16). Ameliyat sonrası 5. yıl DALK uygulanan olgularda ortalama sferik refraktif hata daha yüksek iken (p=0,048); silindirik refraktif hata ve sferik eşdeğer açısından 2 grup arasında istatistiksel anlamlı fark saptanmadı (sırasıyla p1=0,10, p2=0,12). Beş yıl takip süresi sonunda PK ile %93,9, DALK ile %100 greft sağkalımı elde edildi (p=0,17). Takiplerde en sık karşılaşılan komplikasyon, PK uygulanan olgularda %33, DALK uygulanan olgularda %6,5 oranında görülen göz içi basınç (GİB) artışı idi (p=0,08). Sonuç: Keratokonuslu gözlerde PK ve DALK cerrahilerinin uzun dönem görsel sonuçları benzerdir. GİB artışı ve greft reddi PK sonrası daha sık gözlenmektedir. DALK cerrahisi komplikasyonlar açısından daha güvenli bir seçenektir.

Anahtar Kelimeler: Keratokonus; kornea nakli; penetran keratoplasti
ABSTRACT
 Objective: To compare the long-term outcomes of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) surgeries performed for keratoconus. Material and Methods: Medical records of keratoconus patients who underwent PK or DALK were reviewed retrospectively. The patients' best corrected visual acuity (BCVA), spherical and cylindrical refractive error values, and spherical equivalent were recorded before surgery and in the postoperative 5th year. Graft rejection reactions and complications developed during the follow-up period were examined. Results: Sixty-four eyes of 64 patients were included in the study. The patients were followed up for an average of 70.41±10.67 (range=60-96) months. PK was applied to 33 of patients, and DALK was applied to 31. The mean BCVA values at the postoperative 5th year were higher than the preoperative values in both groups (each p-value <0.001). While preoperative BCVA values of the patients who underwent PK were lower than those who underwent DALK (p=0.002); in the postoperative 5th year, BCVA values were statistically similar in the 2 groups (p=0.16). While the mean spherical refractive error was higher in the patients who underwent DALK surgery in the 5th postoperative year (p=0.048), there was no statistically significant difference between the 2 groups in terms of cylindrical refractive error and spherical equivalent (p1=0.10, p2=0.12; respectively). At the end of the 5-year follow-up period, graft survival was 93.9% after PK and 100% after DALK (p=0.17). The most common complication during follow-up was increased intraocular pressure (IOP), which was 33% in patients who underwent PK and 6.5% in patients who underwent DALK (p=0.08). Conclusion: Long-term visual outcomes of PK and DALK surgeries are similar in eyes with keratoconus. Increased IOP and graft rejection are observed more frequently after PK. DALK surgery is a safer option in terms of complications.

Keywords: Keratoconus; corneal transplantation; penetrating keratoplasty
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