South Clin Ist Euras. 2014; 25(2): 95-100 | DOI: 10.5505/jkartaltr.2014.43179

Keratokonus hastalarýnýn tedavisinde býg-bubble tekniði ile yapýlan derin anterior lamellar keratoplasti ameliyatýnýn uzun dönem sonuçlarý

Oðuzhan Genç¹, Esin Söðütlü Sarý^2
1Ergani Devlet Hastanesi Göz Bölümü, Diyarbakýr
²Balýkesir Üniversitesi Týp Merkezi Göz Bölümü, Balýkesir

AMAÇ: Keratokonuslu gözlerde big-bubble tekniði ile uygulanan deep anterior lamellar keratoplasti cerrahisinin (DALK) görsel, refraktif sonuçlarý ve potansiyel komplikasyonlarýný deðerlendirmek.
YÖNTEMLER: Kliniðimizde big-bubble tekniði ile DALK uygulanan 184 keratokonus hastasýnýn 203 gözü çalýsmaya dahil edildi. Cerrahi öncesi ve tüm kontrollerde düzeltilmemiþ görme keskinliði (DGK), düzeltilmiþ en iyi görme keskinliði (DEGK), refraksiyon, keratometrik ölçümler, endotel hücre sayýsý ve biyomikroskobik muayeneyi içeren oftalmik muayene yapýldý, tüm komplikasyonlar rapor edildi.
BULGULAR: DALK cerrahisi sýrasýnda hastalarýn ortalama yaþlarý 26.3 yýl veortalama takip süresi 48,6 aydý. DGK cerrahi öncesi ortalama 0.03 iken son kontrolde gözlerin 178’unda (87,8%) 0,2’den daha iyi idi. DEGK ise cerrahi öncesi ortalama 0,10 iken son kontrolde 0,79 idi. Ortalama maksimum keratometri cerrahi öncesi 61,3 D’den son kontrolde 45,6 D’e geriledi. Ortalamakeratometrik astigmatizma ise cerrahi öncesi 8,6D son kontrol vizitinde ise 3,8 Dolarak ölçüldü. Ortalama endotel hücre sayýsý cerahi öncesi 2769 ± 533 cells/mm², 1. yýlda 2586 ± 572 cells/mm² (6,6% kayýp), 2. yýlda 2521 ± 534 cells/mm² (9,5% kayýp), 6. yýlda 2424 ± 482 cells/mm² (12,6% kayýp) ve son kontrolde 2394± 544 cells/mm² idi. Cerrahi sýrasýnda 26 gözde (12,8%) descement memraný (DM) perforasyonu (mikroperforasyon) gelisti.Erken postoperatif dönemde 8 gözde (3,9%) DM dekolmaný izlendi. Ön kamaraya hava verilmesi ile dekolman 7 gözde düzeldi. DM dekolmaný izlenen gözlerin 1’indeise çift ön kamara gelisti ve bu göze cerrahi sonrasý 6. ayda penetran keratoplastiuygulandý. Gözlerin 7’sinde (3,4%) pupiller bloklu akut glokom krizi geliþti. Takiplerde 5 gözde (2,5%) stromal greft rejeksiyonu geliþti. Medikal tedavi ile rejeksiyon tümgözlerde düzeldi.
SONUÇ: Keratokonuslu gözlerde big-bubble tekniði ile uygulanan DALK cerrahisi baþarýlý görsel ve refraktif sonuçlar saðlamaktadýr. Bu teknik penetran keratoplastiye iyi bir alternatif olarak düþünülebilir.

Anahtar Kelimeler: Keratokonus, penetran keratoplasti, derin anterior lameller keratoplasti, big-bubble tekniði.

---

Techniques in the treatment of keratoconus patients with big-bubble deep anterior lamellar keratoplasty long-term results of operation

Oðuzhan Genç¹, Esin Söðütlü Sarý^2
1Ergani State Hospital Eye Department, Diyarbakýr
²Balýkesir Universitiy, Medical Center Eye Department, Balýkesir

OBJECTIVE: To evaluate the visual and refractive outcomes and potential complications of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in eyes with keratoconus.
METHODS: 203 keratoconic eyes of 184patiens who underwent DALK surgery using the big-bubble technique were included. Preoperatively and at control visits complete ophthalmic examination was performed including uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), refraction, keratometric readings, endothelial cell count and biomicroscopy. Also all surgical complications were recorded.
RESULTS: The mean age of the patients was 26,3 and the mean follow up period was 48,6 months. UCVA was mean 0,03 before surgery. After surgery at the last visit UCVA was beter than 0,2 in 178 eyes (87,8%). The mean BSCVA was improved from 0.1 to 0.79 at the last postoperave examination The meanmaximum keratometry (Kmax) was decreased from 61,3 D (Diopter) to 45,6 D at thelast examination. Preoperative the mean keratometric astigmatism was decreasedfrom 8,6 D to 3,8 D at the last examination. Preoperative the mean endothelial cell count was 2769±533 cells/mm². At the first year it was 2586 ± 572 cells/mm² (6,6%loss) and at the sixty year the mean endothelial cell count was 2424 ± 482cells/mm²(12,6% loss). At last visit the mean endothelial cell count was 2394 ± 544 cells/mm². Descement membrane (DM) microperforation was occured in 26 eyes(12.8%). DM detachment was seen in early postoperative period in 8 eyes (3,9%).After air injection into the anterior chamber DM detachment was fixed in 7 eyes. DMdetachment in one eye developed double anterior chamber and penetratingkeratoplasty was performed after 6 month. Acute glaucoma with pupillary block was seen in 7 eyes (3,4%). Stromal corneal graft rejection was developed in 5 eyes (2,5%) and with medication graft rejection was resolved.
CONCLUSION: In keratoconic eyes, DALK surgery using the big-bubble technique provides good final visual and refractive outcomes with a clearer interface and thus can be considered a reasonable alternative to penetrating keratoplasty.

Keywords: Keratoconus, penetrating keratoplasty, deep anterior lamellar keratoplasty, big-bubble technique.

---

ATIF KOPYALA