Sibel AKYOL, Yasin ÇINAR, Tuba ÇINAR, Muhammet Kazım EROL, Anıl KUBALOĞLU, Erol COŞKUN, Nihal AŞIK, Yusuf ÖZERTÜRK

Penetran keratoplasti ve derin anterior lameller keratoplasti sonrası saydam greftlerde speküler mikroskopik değerlendirme sonuçları

Amaç: Penetran keratoplasti ve derin anterior lameller keratoplasti sonrası saydam greftlerde kornea endotelinde zamana bağlı olarak gelişen değişiklikleri karşılaştırmak. Gereç ve yöntem: Nisan 2003 ve Aralık 2005 tarihleri arasında değişik nedenlerle derin anterior lameller keratoplasti (DALK) uygulanmış 56 göz (DALK grubu) ile penetran keratoplasti uygulanmış (PK) 82 göz (PK grubu) çalışmaya alındı. Ek cerrahi uygulanmamış ve takip süresi içinde (36 ay) greft rejeksiyon atağı, göz içi basıncı yüksekliği gelişmemiş saydam greftlerin ameliyat sonrası 1., 12., 24. ve 36. aylarda yapılan speküler mikroskopi incelemesi ile santral korneal endotel hücre yoğunluğu (EHY) ve değişkenlik katsayısı (DK) değerleri karşılaştırıldı. Bulgular: DALK grubunda endotel hücre yoğunluğu (EHY) 1.ayda 2427±587 hücre/mm² (ortalama±SD), 12.ayda 2289±579 hücre/mm², 24.ayda 2222±541 hücre/mm² ve 36. ayda 2175±521 hücre/mm², PK grubunda ise 1. ayda 2595±589 hücre/mm², 12. ayda 2064±583 hücre/mm², 24. ayda 1759±510 hücre/mm² ve 36. ayda 1509±494 hücre/mm² olarak saptandı. EHY değerlerinde DALK grubunda 1. aya göre 12. ayda %5.9’lük; 24. ayda %7.5’lik ve 36. ayda %9.4’lük azalma görülmekte iken PK grubunda 1. aya göre 12. ayda %18.4’lük; 24. ayda %30.2’lik ve 36. ayda %40.3’lük azalma saptanmıştır. Değişkenlik katsayısı (DK) değerleri DALK grubunda 1. ayda 23.3±6.2 (ortalama±SD), 12. ayda 24.2±6.4, 24. ayda 24.2±6.1 ve 36.ayda 24.5±5.6 iken PK grubunda 1. ayda 19.6±3.4, 12. ayda 23.2±5.4, 24. ayda 25.9±6.2 ve 36. ayda 27.5±5.7 olarak elde edildi. Sonuç: Penetran keratoplasti uygulanmış greftlerde zamanla endotel hücre yoğunluğunda azalma ve polimegatizmdeki artışın derin anterior lameller keratoplasti uygulanmış greftlerden daha fazla olduğu saptanmıştır

Evaluation of specular microscopic results in clear corneal graft after penetrating keratoplasty and deep anterior lamellar keratoplasty

Objectives: To compare endothelial changes after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in clear corneal graft. Methods: In this study, fifty six eyes undergone DALK (DALK Group) and eighty two eyes undergone PK (PK Group) due to various reasons are included. After operation at 1st, 12th, 24th and 36th month central corneal endothelial cell density (CD) and variability coefficient(CV) value examined by specular microscopy of clear graft which have not had additional surgery, greft rejection or glaucoma during follow up period were compared. Results: Endothelial cell density in DALK group were 2426±587 cell/mm² 2289±579 cell/mm², 2222±541 cell/mm², 2175±521 cell/mm², in PK group were 2595±589 cell/mm², 2064±583 cell/mm², 1759±510 cell/mm² 1509±494 cell/mm² at 1st, 12th, 24th and 36th month respectively. Decrease in CD values were 5.9% at 12th month, 7.5% at 24th month and 9.4% at 36th month comparing with first month in DALK group. Decrease in CD values were 18.4% at 12th month, 30.2% at 24th month and 40.3% at 36th month comparing with first month in PK group. Variability coefficient (CV) values in group DALK were 23.3±6.2, 24.2±6.4, 24.2±6.1 and 24.5±5.6 at 1st,12th, 24th and 36th month respectively. Variability coefficient (CV) values in group PK were 19.6±3.4, 23.2±5.4, 25.9±6.2 and 27.5±5.7 at 1st,12th, 24th, and 36th months respectively.

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1. Bourne WM. One year observation of transplanted human corneal endothelium. Ophthalmology 1980;87:673-679.
2. Bourne WM. Cellular changes in transplanted human corneas. Castroviejo lecture. Cornea 2001;20:560-569.
3. Böhringer D, Reinhard T, Spelsberg H, Sundmacher R. Influencing factors on chronic endothelial cell loss characterized in a homogeneous group of patients. Br J Ophthalmol 2002;86:35-38.
4. Bourne WM, Hodge DO, Nelson LR. Corneal endothelium five years after transplantation. Am J Ophthalmol 1994;118:185-196.
5. Patel SV, Hodge DO, Bourne WM. Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty. Am J Ophthalmol 2005;139:311-319.
6. Melles GRJ, Remeijer L, Geerards AJM, Beekhuis WH. A quick surgical technique for deep lamellar keratoplasty using visco-dissection . Cornea 2000;19:427-432.
7. Traffers WF. Human corneal endothelial wound repair; in vitro and in vivo. Ophthalmology 1982;89:605-613.
8. Sugita J, Kondo J. Deep lamellar keratoplasty with complete removal of pathological stroma for vision improvement. Br J Ophthalmol 1997;81:184-188.
9. Panda A, Bageshwar LMS, Ray M, Singh JP, Kumar A. Deep lamellar keratoplasty versus penetrating keratoplasty for corneal lesions. Cornea 1999;18:172-175.
10. Shimazaki J, Shimmura S, Isioka M, Tsubota K. Randomized clinical trial of deep lamellar keratoplasty vs penetrating keratoplasty. Am J Ophthalmol 2002;134:159-165.
11. Morris E, Kirwan JF, Sujatha S, Rostron CK. Corneal endothelial specular microscopy following deep lamellar keratoplasty with lyophilised tissue. Eye 1998;12:619-622.
12. Reinhard T, Böhringer D, Hüschen D, Sundmacher R. Chronic endothelial cell loss of the graft after penetrating keratoplasty: influence of endothelial cell migration from graft to host. Klin Monatsbl Augenheilk 2002;219:410-416.
13. Obbata H, Ishıda K, Murao M et al. Corneal endothelial cell damage in penetrating keratoplasty. Jpn J Ophthalmol. 1991;35:411-416.
14. Ing JJ, Ing HH, Nelson LR, Hodge DO, Bourne WM. Ten-year postoperative results of penetrating keratoplasty. Ophthalmology 1998;105:1855-1865.
15. Van Dooren BTH, Mulder PGH, Nıeuwendaal CP, Beekhuis WH, Melles GRJ. Endothelial cell density after deep anterior lamellar keratoplasty (Melles Technique). Am J Ophthalmol 2004;137:397-400.
16. Böhringer D, Reinhard T, Godehardt E, Sundmacher R. Regression analysis of chronic endothelial cell loss after penetrating normal risk keratoplasty: a retrospective clinical study. Klin Monatsbl Augenheilk 2001;218:412-417.