ophthalmologyОфтальмологияOphthalmology in Russia1816-50952500-0845Ophthalmology10.18008/1816-5095-2023-3-456-459ophthalmology-2171Research ArticleОФТАЛЬМОХИРУРГИЯOPHTHALMOSURGERYИзменения топографии роговицы после глубокой передней послойной кератопластики у пациентов с кератоконусомEvaluation of Corneal Topography Changes Following Deep Anterior Lamellar Keratoplasty in Patients with Keratoconushttps://orcid.org/0000-0002-8557-4673НеслиханК.NeslihanS.

Неслихан Куте

İçerenköy, D100 Üzeri D:İ, 34752 Ataşehir/İstanbul,

Neslihan Sevimli, MD, Assistant Professor, Department of Ophthalmology

İçerenköy, D100 Üzeri D:İ, 34752 Ataşehir/İstanbul

https://orcid.org/0000-0003-0931-8157УмитЧ.ÜmitÇ.

Умит Чалли

İçerenköy, D100 Üzeri D:İ, 34752 Ataşehir/İstanbul,

Ümit Çallı, MD, Department of Ophthalmology

İçerenköy, D100 Üzeri D:İ, 34752 Ataşehir/İstanbul

https://orcid.org/0000-0003-3260-686XФерхатЭ.FerhatE.

Ферхат Эвлияоглу

USA 201 Dowman Dr, Atlanta, GA 30322

Ferhat Evliyaoğlu, MD, Pediatric Ophthalmologist

201 Dowman Dr, Atlanta, GA 30322

https://orcid.org/0000-0003-3049-2571СелимГ.SelimG.

Селим Генч

Стамбул, Бейоглу, махалле Асмалы-Месджит, улица Мешрутиет, 58

Selim Genç, MD, Professor, Department of Ophthalmology

Istanbul, Türkiye Beyoğlu, Asmalı Mescit Mah., Meşrutiyet Cad., 58

Стамбульское провинциальное управление здравоохранения, учебно-исследовательская больница Фати Султан МехметТурцияFatih Sultan Mehmet Training and Research HospitalTurkeyУниверситет ЭмориСоединённые Штаты АмерикиEmory UniversityUnited StatesБейоглу, глазной госпитальТурцияBeyoğlu Eye Research and Training HospitalTurkey202301102023203456459Copyright © Неслихан К., Умит Ч., Ферхат Э., Селим Г., 20232023Неслихан К., Умит Ч., Ферхат Э., Селим Г.Neslihan S., Ümit Ç., Ferhat E., Selim G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ophthalmojournal.com/opht/article/view/2171

Целью данного исследования является оценка морфологических изменений роговицы и передней камеры у пациентов, перенесших глубокую переднюю послойную кератопластику (DALK) по поводу кератоконуса. Пациенты и методы. Было проведено обсервационное исследование «случай — контроль», которое включало 53 глаза 53 пациентов с кератоконусом, перенесших операцию DALK. Все пациенты были обследованы до операции и через 3 месяца после снятия швов с помощью КТ. На КТ оценивали глубину передней камеры (ACD), иридокорнеальный угол (ICA), объем передней камеры (ACV), центральную толщину роговицы (CCT), максимальное кератометрическое значение (Kmax), кератометрию по самому плоскому меридиану (SimK1), кератометрия по самому крутому меридиану (SimK2) и средние результаты кератометрии (SimKavg). Сравнение проводили до и после операции DALK. Результаты. После операции DALK наблюдалось значительное увеличение значений CCT (p < 0,001). У пациентов отмечено статистически значимое снижение значений Kmax, SimK1, SimK2 и SimKavg (p < 0,001 для всех показателей). Послеоперационные значения ACD и ACV были значительно ниже (p < 0,001). Значения ICA не показали достоверной разницы (p = 0,183) между дооперационными и послеоперационными значениями (49,95 ± 5,85 и 46,30 ± 11,33 соответственно). Заключение. Определено резкое снижение кератометрических значений, значений ACD и ACV и увеличение толщины роговицы после операции DALK. Таким образом, DALK может оказывать значительное влияние на переднюю камеру глаза.

Background. The aim of this study is to evaluate the morphologic changes of the cornea and anterior chamber by using corneal topography (CT) in patients undergoing deep anterior lamellar keratoplasty (DALK) due to keratoconus. Patients and methods. This observational case-control study included total 53 eyes of 53 patients with keratoconus and underwent DALK surgery. All patients were evaluated preoperatively and 3 months after suture removal with CT. In CT, anterior chamber depth (ACD), iridocorneal angle (ICA), anterior chamber volume (ACV), central corneal thickness (CCT), maximum keratometric value (Kmax), flattest simulated meridian keratometry (SimK1), steepest simulated meridian keratometry (SimK2) and simulated keratometry average (SimKavg) results were compared before and after DALK surgery. Results. A significant increase was observed in CCT values after DALK surgery (p < 0.001). Patients showed statistically significant decrease in Kmax, SimK1, SimK2 and SimKavg values (p < 0.001 for all). Postoperative ACD and ACV values were significantly lower (p < 0.001). The ICA values showed no significant difference (p = 0.183) between preoperative and postoperative values (49,95 ± 5,85 and 46,30 ± 11,33 respectively). Conclusion. We determined a dramatic decrease in keratometric values, ACD and ACV values and an increase of corneal thickness after DALK surgery. Although DALK can be performed without interfering with the anterior chamber, has a significant effect in anterior chamber.

глубина передней камерыглубокая передняя послойная кератопластикаиридокорнеальный уголкератоконустопография роговицыAnterior chamber depthdeep anterior lamellar keratoplastyiridocorneal anglekeratoconuscorneal topographyReferencesMohammadpour M, Heidari Z, Hashemi H. Updates on Managements for Keratoconus. J Curr Ophthalmol. 2017 Dec 6;30(2):110-124. doi: 10.1016/j.joco.2017.11.002.Mohammadpour M, Heidari Z, Hashemi H. Updates on Managements for Keratoconus. J Curr Ophthalmol. 2017 Dec 6;30(2):110-124. doi: 10.1016/j.joco.2017.11.002.Spadea L, De Rosa V. Current techniques of lamellar keratoplasty for keratoconus. Saudi Med J. 2016 Feb;37(2):127-36. doi: 10.15537/smj.2016.2.12985.Spadea L, De Rosa V. Current techniques of lamellar keratoplasty for keratoconus. Saudi Med J. 2016 Feb;37(2):127-36. doi: 10.15537/smj.2016.2.12985.Doctor K, Vunnava KP, Shroff R, Kaweri L, Lalgudi VG, Gupta K, Kundu G. Simplifying and understanding various topographic indices for keratoconus using Scheimpflug based topographers. Indian J Ophthalmol. 2020 Dec;68(12):2732-2743. doi: 10.4103/ijo.IJO_2111_20.Doctor K, Vunnava KP, Shroff R, Kaweri L, Lalgudi VG, Gupta K, Kundu G. Simplifying and understanding various topographic indices for keratoconus using Scheimpflug based topographers. Indian J Ophthalmol. 2020 Dec;68(12):2732- 2743. doi: 10.4103/ijo.IJO_2111_20.Doctor K, Vunnava KP, Shroff R, Kaweri L, Lalgudi VG, Gupta K, Kundu G. Simplifying and understanding various topographic indices for keratoconus using Scheimpflug based topographers. Indian J Ophthalmol. 2020 Dec;68(12):2732-2743. doi: 10.4103/ijo.IJO_2111_20.Doctor K, Vunnava KP, Shroff R, Kaweri L, Lalgudi VG, Gupta K, Kundu G. Simplifying and understanding various topographic indices for keratoconus using Scheimpflug based topographers. Indian J Ophthalmol. 2020 Dec;68(12):2732-2743. doi: 10.4103/ijo.IJO_2111_20.Ort A, Gunes A, Kandemir B, Calisir K, Kalayci M, Genc O, et al. Ort A, Gunes A, Kandemir B, Calısır K, Kalaycı M, Genc O, Ozerturk Y. Evaluation of the Cornea and Anterior Chamber Morphologic Changes After Penetrating Keratoplasty in Patients With Keratoconus. Eye Contact Lens. 2017 Jul;43(4):236-239. doi: 10.1097/ICL.0000000000000260. doi: 10.1097/ICL.0000000000000260Ort A, Gunes A, Kandemir B, Calisir K, Kalayci M, Genc O, et al. Ort A, Gunes A, Kandemir B, Calısır K, Kalaycı M, Genc O, Ozerturk Y. Evaluation of the Cornea and Anterior Chamber Morphologic Changes After Penetrating Keratoplasty in Patients With Keratoconus. Eye Contact Lens. 2017 Jul;43(4):236-239. doi: 10.1097/ICL.0000000000000260. doi: 10.1097/ICL.0000000000000260Italon C, Pieh S, Hanselmayer G, Kahraman G, Kaminski S, Skorpik C, Dejaco-Ruhswurm I. Changes of axial length and keratometry after keratoplasty for keratoconus using the guided trephine system. Am J Ophthalmol. 2002 Nov;134(5):696-700. doi: 10.1016/s0002-9394(02)01674-4.7.Italon C, Pieh S, Hanselmayer G, Kahraman G, Kaminski S, Skorpik C, Dejaco- Ruhswurm I. Changes of axial length and keratometry after keratoplasty for keratoconus using the guided trephine system. Am J Ophthalmol. 2002 Nov;134(5):696- 700. doi: 10.1016/s0002-9394(02)01674-4.7.Ruhswurm I, Scholz U, Pfleger T, Zehetmayer M, Hanselmayer G, Skorpik C. Threeyear clinical outcome after penetrating keratoplasty for keratoconus with the guided trephine system. Am J Ophthalmol. 1999 Jun;127(6):666-73. doi: 10.1016/s0002-9394(99)00036-7.Ruhswurm I, Scholz U, Pfleger T, Zehetmayer M, Hanselmayer G, Skorpik C. Threeyear clinical outcome after penetrating keratoplasty for keratoconus with the guided trephine system. Am J Ophthalmol. 1999 Jun;127(6):666-73. doi: 10.1016/s0002-9394(99)00036-7.Yüksel B, Kandemir B, Uzunel UD, Çelik O, Ceylan S, Küsbeci T. Comparison of visual and topographic outcomes of deep-anterior lamellar keratoplasty and penetrating keratoplasty in keratoconus. Int J Ophthalmol. 2017 Mar 18;10(3):385-390. doi: 10.18240/ijo.2017.03.10.Yüksel B, Kandemir B, Uzunel UD, Çelik O, Ceylan S, Küsbeci T. Comparison of visual and topographic outcomes of deep-anterior lamellar keratoplasty and penetrating keratoplasty in keratoconus. Int J Ophthalmol. 2017 Mar 18;10(3):385-390. doi: 10.18240/ijo.2017.03.10.Liu H, Chen Y, Wang P, Li B, Wang W, Su Y, Sheng M. Efficacy and safety of deep anterior lamellar keratoplasty vs. penetrating keratoplasty for keratoconus: a meta-analysis. PLoS One. 2015 Jan 29;10(1):e0113332. doi: 10.1371/journal.pone.0113332.Liu H, Chen Y, Wang P, Li B, Wang W, Su Y, Sheng M. Efficacy and safety of deep anterior lamellar keratoplasty vs. penetrating keratoplasty for keratoconus: a meta-analysis. PLoS One. 2015 Jan 29;10(1):e0113332. doi: 10.1371/journal.pone.0113332.Henein C, Nanavaty MA. Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus. Cont Lens Anterior Eye. 2017 Feb;40(1):3-14. doi: 10.1016/j.clae.2016.10.001.Henein C, Nanavaty MA. Systematic review comparing penetrating keratoplasty and deep anterior lamellar keratoplasty for management of keratoconus. Cont Lens Anterior Eye. 2017 Feb;40(1):3-14. doi: 10.1016/j.clae.2016.10.001.Riss S, Heindl LM, Bachmann BO, Kruse FE, Cursiefen C. Pentacam-based big bubble deep anterior lamellar keratoplasty in patients with keratoconus. Cornea. 2012 Jun;31(6):627-32. doi: 10.1097/ICO.0b013e31823f8c85.Riss S, Heindl LM, Bachmann BO, Kruse FE, Cursiefen C. Pentacam-based big bubble deep anterior lamellar keratoplasty in patients with keratoconus. Cornea. 2012 Jun;31(6):627-32. doi: 10.1097/ICO.0b013e31823f8c85.Arantes JCD, Coscarelli S, Ferrara P, Araújo LPN, Ávila M, Torquetti L. Intrastromal Corneal Ring Segments for Astigmatism Correction after Deep Anterior Lamellar Keratoplasty. J Ophthalmol. 2017;2017:8689017. doi: 10.1155/2017/8689017.Arantes JCD, Coscarelli S, Ferrara P, Araújo LPN, Ávila M, Torquetti L. Intrastromal Corneal Ring Segments for Astigmatism Correction after Deep Anterior Lamellar Keratoplasty. J Ophthalmol. 2017;2017:8689017. doi: 10.1155/2017/8689017.Qin Q, Yang L, He Z, Huang Z. Clinical application of TICL implantation for ametropia following deep anterior lamellar keratoplasty for keratoconus: A CONSORT-compliant article. Medicine (Baltimore). 2017 Feb;96(8):e6118. doi: 10.1097/MD.0000000000006118.Qin Q, Yang L, He Z, Huang Z. Clinical application of TICL implantation for ametropia following deep anterior lamellar keratoplasty for keratoconus: A CONSORT- compliant article. Medicine (Baltimore). 2017 Feb;96(8):e6118. doi: 10.1097/MD.0000000000006118.Wolfs RC, Klaver CC, Vingerling JR, Grobbee DE, Hofman A, de Jong PT. Distribution of central corneal thickness and its association with intraocular pressure: The Rotterdam Study. Am J Ophthalmol. 1997 Jun;123(6):767-72. doi: 10.1016/s0002-9394(14)71125-0.Wolfs RC, Klaver CC, Vingerling JR, Grobbee DE, Hofman A, de Jong PT. Distribution of central corneal thickness and its association with intraocular pressure: The Rotterdam Study. Am J Ophthalmol. 1997 Jun;123(6):767-72. doi: 10.1016/s0002-9394(14)71125-0.J Jabbour S, Muzychuk A, Agoumi Y, Harissi-Dagher M. An unusual case of acute angle-closure glaucoma following deep anterior lamellar keratoplasty using the “big bubble” technique. Am J Ophthalmol Case Rep. 2017 Jun 22;7:126-128. doi: 10.1016/j.ajoc.2017.06.013.J Jabbour S, Muzychuk A, Agoumi Y, Harissi-Dagher M. An unusual case of acute angle-closure glaucoma following deep anterior lamellar keratoplasty using the “big bubble” technique. Am J Ophthalmol Case Rep. 2017 Jun 22;7:126-128. doi: 10.1016/j.ajoc.2017.06.013.

The authors declare that there are no conflicts of interest present.