| Long-term results of deep anterior lamellar versus penetrating keratoplasty. | |
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MedLine Citation:
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PMID: 22054997 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To compare deep anterior lamellar keratoplasty (DALK) with penetrating keratoplasty (PK) in eyes with corneal diseases not involving the corneal endothelium (keratoconus, scars after infectious keratitis, stromal dystrophies, and trauma). DESIGN: Retrospective, comparative case series. PARTICIPANTS: One hundred forty-two consecutive DALK (DALK group; big-bubble technique or manual lamellar dissection using a slitlamp) and 142 matched PK (PK group). METHODS: Three models were used to describe the postoperative outcomes of the endothelial cell density. A joint regression model was used to predict long-term graft survival. Visual acuity, ultrasound pachymetry, specular microscopy, and optical coherence tomography (OCT) findings were recorded. MAIN OUTCOME MEASURES: Postoperative endothelial cell loss and long-term predicted graft survival. RESULTS: The average 5-year postoperative endothelial cell loss was -22.3% in the DALK group and -50.1% in the PK group (P<0.0001). The early- and late-phase annual rates of endothelial cell loss were -8.3% and -3.9% per year, respectively, in the DALK group and -15.2% and -7.8% per year in the PK group (P<0.001; biphasic linear model). The median predicted graft survival was 49.0 years in the DALK group and 17.3 years in the PK group (P<0.0001). The average visual acuity was lower in the manual dissection subgroup compared with the PK group (average difference, 1.0 to 1.8 line) and with the big-bubble subgroup (average difference, 2.2 to 2.5 lines). The average central corneal thickness at 12 months was 536 μm in the PK group, 523 μm in the big-bubble subgroup, and 562 μm in the manual dissection subgroup (P<0.001). The average thickness of the residual recipient stroma measured by OCT was 87±26 μm in the manual dissection subgroup. No correlation was found between this figure and logarithm of the minimal angle of resolution at any postoperative time point (P>0.05). CONCLUSIONS: Long-term, model-predicted graft survival and endothelial densities are higher after DALK than after PK. The big-bubble technique gives better results than manual dissection and PK. Compared with PK, manual dissection provides higher survival of both the corneal endothelium and graft, but lower visual acuity. |
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Authors:
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Vincent M Borderie; Otman Sandali; Julien Bullet; Thomas Gaujoux; Olivier Touzeau; Laurent Laroche |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't Date: 2011-11-04 |
Journal Detail:
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Title: Ophthalmology Volume: 119 ISSN: 1549-4713 ISO Abbreviation: Ophthalmology Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-02-06 Completed Date: 2012-03-22 Revised Date: 2013-02-12 |
Medline Journal Info:
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Nlm Unique ID: 7802443 Medline TA: Ophthalmology Country: United States |
Other Details:
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Languages: eng Pagination: 249-55 Citation Subset: IM |
Copyright Information:
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Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Centre Hospitalier National d’Ophtalmologie des XV-XX, 28 rue de Charenton, 75012 Paris, France. vincent.borderie@upmc.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Astigmatism / physiopathology Cell Count Corneal Diseases / physiopathology, surgery* Corneal Endothelial Cell Loss / physiopathology Corneal Transplantation* Endothelium, Corneal / pathology Female Follow-Up Studies Graft Survival / physiology Humans Keratoplasty, Penetrating* Male Microscopy, Acoustic Retrospective Studies Tomography, Optical Coherence Treatment Outcome Visual Acuity / physiology |
| Comments/Corrections | |
Comment In:
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Ophthalmology. 2013 Jan;120(1):216
[PMID:
23283193
]
Ophthalmology. 2013 Jan;120(1):216-7 [PMID: 23283194 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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