Clinical & experimental ophthalmology · 2018
Long-term outcomes of hemi-automated lamellar keratoplasty.
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Fuest Matthias, Liu Yu-Chi, Arundhati Anshu, Li Lim, Tan Donald, Mehta Jodhbir S
Аннотация
IMPORTANCE: To describe long-term outcomes of hemi-automated lamellar keratoplasty (HALK).
BACKGROUND: HALK is a hybrid anterior lamellar keratoplasty technique for corneas with anterior to mid-stromal scars and topographical irregularities.
DESIGN: Prospective interventional case series.
PARTICIPANTS: Thirty-five eyes of 35 consecutive patients undergoing HALK at a single tertiary referral centre from 2007 to 2016.
METHODS: Patients were followed up for a mean period of 61.4 ± 29.2 months.
MAIN OUTCOME MEASURE: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE) and cylinder, endothelial cell density (ECD), central corneal thickness (CCT), graft survival and complications were analysed.
RESULTS: The most common indications for HALK were scars because of contact lens associated infectious keratitis (29%), unknown origin (26%) or corneal dystrophies (14%). Five patients had a previous keratoplasty (n = 4; deep anterior lamellar keratoplasty, n = 1). Two HALKs failed at 22 and 32 months follow-up. No graft rejections occurred. UCVA improved from 0.91 ± 0.31 to 0.58 ± 0.35 and BSCVA from 0.66 ± 0.30 to 0.21 ± 0.20 logMAR (P < 0.001) at the last follow-up. Astigmatism (P = 0.2), SE (P = 0.8) and ECD (P = 0.4) did not change significantly during follow-up. CCT increased from 490 to 560 μm (P = 0.004). Kaplan-Meier estimated survival for all HALK cases was 90.6 (95% confidence interval 82.6-98.5) months with a survival probability of 96% at 12 months and 92% at 3, 5 and 7 years of follow-up.
CONCLUSIONS AND RELEVANCE: HALK provides excellent graft survival in primary cases and in patients with prior keratoplasty as well as significant improvement in visual acuity with low complication rates.
BACKGROUND: HALK is a hybrid anterior lamellar keratoplasty technique for corneas with anterior to mid-stromal scars and topographical irregularities.
DESIGN: Prospective interventional case series.
PARTICIPANTS: Thirty-five eyes of 35 consecutive patients undergoing HALK at a single tertiary referral centre from 2007 to 2016.
METHODS: Patients were followed up for a mean period of 61.4 ± 29.2 months.
MAIN OUTCOME MEASURE: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE) and cylinder, endothelial cell density (ECD), central corneal thickness (CCT), graft survival and complications were analysed.
RESULTS: The most common indications for HALK were scars because of contact lens associated infectious keratitis (29%), unknown origin (26%) or corneal dystrophies (14%). Five patients had a previous keratoplasty (n = 4; deep anterior lamellar keratoplasty, n = 1). Two HALKs failed at 22 and 32 months follow-up. No graft rejections occurred. UCVA improved from 0.91 ± 0.31 to 0.58 ± 0.35 and BSCVA from 0.66 ± 0.30 to 0.21 ± 0.20 logMAR (P < 0.001) at the last follow-up. Astigmatism (P = 0.2), SE (P = 0.8) and ECD (P = 0.4) did not change significantly during follow-up. CCT increased from 490 to 560 μm (P = 0.004). Kaplan-Meier estimated survival for all HALK cases was 90.6 (95% confidence interval 82.6-98.5) months with a survival probability of 96% at 12 months and 92% at 3, 5 and 7 years of follow-up.
CONCLUSIONS AND RELEVANCE: HALK provides excellent graft survival in primary cases and in patients with prior keratoplasty as well as significant improvement in visual acuity with low complication rates.