深層層状角膜移植術と全層角膜移植術の長期成績比較

Comparison of long-term outcome of penetrating and deep anterior lamellar keratoplasty

要約　目的：深層層状角膜移植術と全層角膜移植術の長期成績の比較。対象と方法：過去10年間に同一術者が角膜移植を行った36例を対象とした。男性27例，女性9例で，円錐角膜25例，角膜白斑7例，角膜変性3眼であった。15例には深層層状角膜移植術，21例には全層角膜移植術を行った。術後経過は2～10年，平均約5年間追跡した。結果：最終平均視力は深層層状角膜移植群が0.72，全層角膜移植群が0.85で，有意差はなかった。術後の等価球面度数は近視化したが，両群間に有意差はなかった。術直後の角膜内皮細胞減少率は，深層層状角膜移植群が11.0±16.6％，全層角膜移植群が59.5±29.0％で，有意差があった（p＜0.01）。結論：深層層状角膜移植後の2年以上の視機能の経過は，全層角膜移植後とほぼ同等であり，かつ安全であった。

Abstract.　Purpose：To report and compare the long-term outcome of penetrating and deep anterior lamellar keratoplasty. Cases and Method：This retrospective study was made on 36 cases who received keratoplasty by a single surgeon during past 10 years. The series comprised 27 males and 9 females. There were 25 eyes of keratoconus, 7 eyes of corneal leukoma, and 3 eyes of corneal degeneration. Deep anterior lamellar keratoplasty was performed on 21 cases and penetrating keratoplasty on 21 eyes. Cases were followed up for 2 to 10 years, average 5 years. Results：Final visual acuity averaged 0.72 after lamellar and 0.85 after penetrating keratoplasty. There was no significant difference. Spherical equivalent of refraction showed a tendency to myopia with no difference between the two groups. Corneal endothelial cell density decreased by 11.0±6.6％ immediately after lamellar and 59.5±29.0％ after penetrating keratoplasty（p＜0.01）. Conclusion：There was no difference in visual function and safety between deep anterior lamellar keratoplasty and penetrating keratoplasty for 2 years or longer.