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Klin Monbl Augenheilkd 2018; 235(04): 404-408
DOI: 10.1055/s-0044-101828
Klinische Studie
Georg Thieme Verlag KG Stuttgart · New York

12-Year Outcomes of Microkeratome-Assisted Anterior Lamellar Therapeutic Keratoplasty (ALTK) for Disorders of the Anterior Part of the Corneal Stroma – A Comparative Review of Adult and Children

12-Jahres-Resultate nach mikrokeratomassistierter anteriorer lamellierender therapeutischer Keratoplastik (ALTK) für Erkrankungen des anterioren Hornhautstromas – Vergleich von Erwachsenen und Kindern
Ivo Guber
1   Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
2   Ophthalmology, Universite de Geneve Faculte de Medecine, Geneve, Switzerland
,
Ciara Bergin
1   Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
,
Philippe Othenin-Girard
1   Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
,
Francis Munier
1   Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
,
François Majo
1   Ophthalmology, Jules Gonin Eye Hospital, Lausanne, Switzerland
› Author Affiliations
Further Information

Publication History

received 20 September 2017

accepted 21 January 2018

Publication Date:
18 April 2018 (online)

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Abstract

Purpose To report the visual outcomes and complications of automated anterior lamellar therapeutic keratoplasty (ALTK) in adults and children, and to examine these outcomes as a function of age and etiology.

Methods A consecutive series of cases undergoing automated ALTK procedures performed at the Jules-Gonin Eye Hospital Lausanne, Switzerland, between June 2003 and January 2015. Only patients with at least 3 months of follow-up were included.

Results There were 53 eyes (24 right) of 51 patients (17 female, 16 juvenile), with a mean age of 34.8 years (range from 3 months to 88 years), analyzed. The mean follow-up was 35 (± 26) months. Diagnosis in the adult (n = 37) vs. juvenile (n = 16) eyes was different: opacity following surgical complication 8 vs. 0, congenital 1 vs. 1, dystrophy 5 vs. 2, infection 12 vs. 5, keratectasia 3 vs. 0, trauma 7 vs. 0, tumor 1 vs. 3, and allergy 0 vs. 5. Visual impairment as a consequence of corneal scarring was the principle indication for surgery in both adult (70%; 26) and juvenile eyes (63%; 10); other indications were choristoma, dermoid, other tumors, astigmatism, and congenital opacity. In adult vs. juvenile eyes, the mean visual acuity (spectacle and contact lenses) was, at last visit, 0.55 vs. 0.45 LogMAR (p = 0.78), with a range of 100% to hand movements. Failure occurred in 6 (16%) vs. 2 (13%) cases and complications were observed in 14 (38%) vs. 9 (56%) cases, however, more surgical revision was required in juvenile eyes, 4 (11%) vs. 7 (43%) (p = 0.01, Fisher test).

Conclusions This study shows that anterior lamellar keratoplasty in children retains good visual function when combined with adequate amblyopic therapy. However, the rate of complications is higher in juveniles and requires more intensive interdisciplinary follow-up.

Zusammenfassung

Hintergrund Der Visus und die Komplikationen nach automatisierter anteriorer lamellierender therapeutischer Keratoplastik (ALTK) bei Kindern und Erwachsenen wurden ausgewertet in Abhängigkeit von Alter und Ursache.

Patienten und Methoden Konsekutive Fallserie nach automatisierter ALTK, durchgeführt im Jules Gonin Augenspital Lausanne, Schweiz, zwischen 01.06.2003 und 01.01.2015. Nur Patienten mit einem Verlauf von mindestens 3 Monaten wurden eingeschlossen.

Resultate 53 Augen (24 rechte) von 51 Patienten (17 Frauen, 16 Kinder unter 16 Jahren) mit einem Durchschnittsalter von 34,8 Jahren (von 3 Monaten bis 88 Jahren) wurden analysiert. Das Follow-up betrug 35 (± 26) Monate. Die Diagnosen in adulten vs. juvenilen Augen waren verschieden: Trübungen infolge chirurgischer Komplikation 8 vs. 0, kongenital 1 vs. 1, Dystrophie 5 vs. 2, Infektion 12 vs. 5, Keratektasie 3 vs. 0, Trauma 7 vs. 0, Tumor 1 vs. 3 und Allergie 0 vs. 5. Visusminderung als Konsequenz einer Hornhautnarbe war die Hauptindikation für den Eingriff in beiden Gruppen, adulte (70%; 26) und juvenile Augen (63%; 10), andere Indikationen waren Choristom, Dermoid, andere Tumoren, Astigmatismus und andere kongenitale Trübungen. Der Durchschnittsvisus bei der letzten Konsultation in adulten vs. juvenilen Augen war 0,55 vs. 0,45 logMAR (p = 0,78), Bandbreite von 100% bis Handbewegungen, Versagen kam in 6 (16%) vs. 2 (13%) der Fälle vor und Komplikationen wurden in 14 (38%) vs. 9 (56%) der Fälle beobachtet, jedoch wurden mehr chirurgische Revisionen in juvenilen Augen benötigt (4 [11%] vs. 7 [43%]) (p = 0,01, Fisher-Test).

Schlussfolgerungen Diese Studie zeigt, dass die anteriore lamellierende Keratoplastik zu einer guten Sehfunktion bei Kindern führt, falls sie kombiniert wird mit einer adäquaten Amblyopietherapie. Jedoch ist die Komplikationsrate höher als bei Erwachsenen und benötigt eine intensivere interdisziplinäre Behandlung.

Key words

cornea - corneal graft - lamellar keratoplasty - anterior lamellar keratoplasty - microkeratome

Schlüsselwörter

Hornhaut - Hornhauttransplantation - lamellierende Keratoplastik - anteriore lamellierende Keratoplastik - Mikrokeratom
 

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