Full Text:   <342>

Summary:  <142>

CLC number: R779.65

On-line Access: 2018-11-02

Received: 2018-04-15

Revision Accepted: 2018-07-12

Crosschecked: 2018-10-22

Cited: 0

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Citations:  Bibtex RefMan EndNote GB/T7714


Yu-feng Yao


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Journal of Zhejiang University SCIENCE B 2018 Vol.19 No.11 P.863-870


Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty

Author(s):  Bing-hong Wang, Ye-sheng Xu, Wen-jia Xie, Yu-feng Yao

Affiliation(s):  Department of Ophthalmology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China

Corresponding email(s):   yaoyf@zju.edu.cn

Key Words:  Full-bed deep anterior lamellar keratoplasty, Corneal thickness distribution, Corneal apex

Bing-hong Wang, Ye-sheng Xu, Wen-jia Xie, Yu-feng Yao. Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty[J]. Journal of Zhejiang University Science B, 2018, 19(11): 863-870.

@article{title="Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty",
author="Bing-hong Wang, Ye-sheng Xu, Wen-jia Xie, Yu-feng Yao",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty
%A Bing-hong Wang
%A Ye-sheng Xu
%A Wen-jia Xie
%A Yu-feng Yao
%J Journal of Zhejiang University SCIENCE B
%V 19
%N 11
%P 863-870
%@ 1673-1581
%D 2018
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1800230

T1 - Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty
A1 - Bing-hong Wang
A1 - Ye-sheng Xu
A1 - Wen-jia Xie
A1 - Yu-feng Yao
J0 - Journal of Zhejiang University Science B
VL - 19
IS - 11
SP - 863
EP - 870
%@ 1673-1581
Y1 - 2018
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1800230

Objective: To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty (FBDALK). Methods: This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior (S-I) and nasal-temporal (N-T) corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center (S-I2 mm, S-I4 mm, S-I6 mm, S-I8 mm, N-T2 mm, N-T4 mm, N-T6 mm, and N-T8 mm), the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex (TA3 mm), the astigmatic vector values J0 and J45, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters (HOA3 mm and HOA6 mm). Statistical analysis was performed by SPSS 15.0. Results: A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was (28±7) months. The mean UCVA was 0.45±0.23 (logMAR) (MAR: minimum angle of resolution) and the mean BSCVA was 0.19±0.15 (logMAR), which were all significantly positively correlated with postoperative TA3 mm and HOA3 mm. The mean S-I corneal thickness differences were (44.62±37.74) μm, and the mean N-T was (38.57±32.29) μm. S-I2 mm was significantly positively correlated with J0 (r=0.31), J45 (r=0.42), HOA3 mm (r=0.37), and HOA6 mm (r=0.48). S-I4 mm and S-I8 mm were significantly positively correlated with HOA3 mm (r=0.30, r=0.40) and HOA6 mm (r=0.46, r=0.35). The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J45 (r=0.29). Conclusions: In patients with advanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.




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[1]Ashwin PT, Shah S, Pushpoth S, et al., 2009. The relationship of Central Corneal Thickness (CCT) to Thinnest Central Cornea (TCC) in healthy adults. Cont Lens Anterior Eye, 32(2):64-67.

[2]Bae GH, Kim JR, Kim CH, et al., 2014. Corneal topographic and tomographic analysis of fellow eyes in unilateral keratoconus patients using Pentacam. Am J Ophthalmol, 157(1):103-109.e1.

[3]Bonci P, Della Valle V, Bonci P, et al., 2011. Deep anterior lamellar keratoplasty with dehydrated, 4 °C-stored, and rehydrated lenticules. Eur J Ophthalmol, 21(4):368-373.

[4]Boote C, Dennis S, Meek K, 2004. Spatial mapping of collagen fibril organisation in primate cornea—an X-ray diffraction investigation. J Struct Biol, 146(3):359-367.

[5]Daxer A, Fratzl P, 1997. Collagen fibril orientation in the human corneal stroma and its implication in keratoconus. Invest Ophthalmol Vis Sci, 38(1):121-129.

[6]Espandar L, Mandell JB, Niknam S, 2016. Femtosecond laser-assisted decagonal deep anterior lamellar keratoplasty. Can J Ophthalmol, 51(2):67-70.

[7]Fares U, Otri AM, Al-Aqaba MA, et al., 2012a. Correlation of central and peripheral corneal thickness in healthy corneas. Cont Lens Anterior Eye, 35(1):39-45.

[8]Fares U, Sarhan ARS, Dua HS, 2012b. Management of post-keratoplasty astigmatism. J Cataract Refract Surg, 38(11):2029-2039.

[9]Javadi MA, Motlagh BF, Jafarinasab MR, et al., 2005. Outcomes of penetrating keratoplasty in keratoconus. Cornea, 24(8):941-946.

[10]Javadi MA, Feizi S, Rastegarpour A, 2011. Effect of vitreous length and trephine size disparity on post-DALK refractive status. Cornea, 30(4):419-423.

[11]Javadi MA, Feizi S, Javadi F, et al., 2014. Deep anterior lamellar keratoplasty using fresh versus cryopreserved corneas. Ophthalmology, 121(2):610-611.

[12]Khoramnia R, Rabsilber TM, Auffarth GU, 2007. Central and peripheral pachymetry measurements according to age using the Pentacam rotating Scheimpflug camera. J Cataract Refract Surg, 33(5):830-836.

[13]Nam SM, Im CY, Lee HK, et al., 2010. Accuracy of RTVue optical coherence tomography, Pentacam, and ultrasonic pachymetry for the measurement of central corneal thickness. Ophthalmology, 117(11):2096-2103.

[14]Özyol P, Özyol E, 2016. Agreement between swept-source optical biometry and scheimpflug-based topography measurements of anterior segment parameters. Am J Ophthalmol, 169:73-78.

[15]Pandolfi A, Holzapfel GA, 2008. Three-dimensional modeling and computational analysis of the human cornea considering distributed collagen fibril orientations. J Biomech Eng, 130(6):061006.

[16]Petsche SJ, Chernyak D, Martiz J, et al., 2012. Depth-dependent transverse shear properties of the human corneal stroma. Invest Ophthalmol Vis Sci, 53(2):873-880.

[17]Ponce CMP, Rocha KM, Smith SD, et al., 2009. Central and peripheral corneal thickness measured with optical coherence tomography, Scheimpflug imaging, and ultrasound pachymetry in normal, keratoconus-suspect, and post-laser in situ keratomileusis eyes. J Cataract Refract Surg, 35(6):1055-1062.

[18]Sarhan ARS, Dua HS, Beach M, 2000. Effect of disagreement between refractive, keratometric, and topographic determination of astigmatic axis on suture removal after penetrating keratoplasty. Br J Ophthalmol, 84(8):837-841.

[19]Serdarevic ON, 1994. Refractive corneal transplantation: control of astigmatism and ametropia during penetrating keratoplasty. Int Ophthalmol Clin, 34(4):13-33.

[20]Shankar H, Taranath D, Santhirathelagan CT, et al., 2008. Anterior segment biometry with the Pentacam: comprehensive assessment of repeatability of automated measurements. J Cataract Refract Surg, 34(1):103-113.

[21]Uçakhan ÖÖ, Özkan M, Kanpolat A, 2006. Corneal thickness measurements in normal and keratoconic eyes: Pentacam comprehensive eye scanner versus noncontact specular microscopy and ultrasound pachymetry. J Cataract Refract Surg, 32(6):970-977.

[22]Vajpayee RB, Sharma V, Sharma N, et al., 2001. Evaluation of techniques of single continuous suturing in penetrating keratoplasty. Br J Ophthalmol, 85(2):134-138. http://doi.org/10.1136/bjo.85.2.134

[23]Wu SQ, Zhou P, Zhang B, et al., 2012. Long-term comparison of full-bed deep lamellar keratoplasty with penetrating keratoplasty in treating corneal leucoma caused by herpes simplex keratitis. Am J Ophthalmol, 153(2):291-299.e2.

[24]Yao YF, 2008. A novel technique for performing full-bed deep lamellar keratoplasty. Cornea, 27(Suppl 1):S19-S24.

[25]Yao YF, Zhang B, Zhou P, et al., 2002. Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage. Ophthalmology, 109(11):2011-2017.

[26]Zhang YM, Wu SQ, Yao YF, 2013. Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus. J Zhejiang Univ-Sci B (Biomed & Biotechnol), 14(5):438-450.

[27]Zheng YF, Huang GF, Huang WY, et al., 2008. Distribution of central and peripheral corneal thickness in Chinese children and adults: the Guangzhou twin eye study. Cornea, 27(7):776-781.

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