飞秒激光辅助的角膜基质透镜植入术矫正远视的早期临床观察  

Early clinical study of femtosecond laser-assisted intrastromal lenticular implantation in correcting hyperopia

作　　者：晏利 凌玲[1] 喻理[1] 徐婉欣 查琴 谢丽萍 高菲菲 周文天[1] YAN Li;LING Ling;YU Li;XU Wanxin;ZHA Qin;XIE Liping;GAO Feifei;ZHOU Wentian(Affiliated Eye Hospital of Nanchang University,Nanchang 330006,Jiangxi Province,China;Jiangxi Province Tumor Hospital,Nanchang 330029,Jiangxi Province,China)

机构地区：[1]南昌大学附属眼科医院,江西省南昌市330006 [2]江西省肿瘤医院,江西省南昌市330029

出　　处：《眼科新进展》2020年第8期751-754,760,共5页Recent Advances in Ophthalmology

基　　金：江西省卫生计生委科技计划项目(编号20165303)。

摘　　要：目的探讨飞秒激光辅助的角膜基质透镜植入术矫正远视的早期安全性及疗效。方法前瞻性研究。对7例9眼远视患者行飞秒激光辅助的角膜基质透镜植入术,术后随访6个月。观察术后裸眼远视力、裸眼近视力、最佳矫正远视力、等效球镜度数、眼压、角膜曲率、角膜一般情况及神经生长情况等。结果所有患者手术均顺利完成,仅1例(1眼)术后4个月发生角膜排斥反应。术后早期角膜基质水肿,术后1个月、3个月水肿消失;术后6个月,透镜与周边组织完全融合,无法识别边界。术后各时间点裸眼近视力、裸眼远视力、等效球镜度数均较术前改善,角膜平坦轴曲率、角膜陡峭轴曲率、中央角膜厚度均较术前明显增加。术后角膜平均曲率及眼压与术前比较变化不大,差异均无统计学意义(均为P>0.05)。术后角膜OCT检查显示(除发生角膜排斥反应的1眼外)角膜表面光滑,基质透镜透明、在位。术后角膜激光共聚焦显微镜检查术后1周,角膜组织水肿,透镜组织及角膜基质层均可见活化的角膜基质细胞,随时间延长,角膜水肿消退,基质细胞逐渐呈静止状态,并可见神经纤维。结论飞秒激光辅助的角膜基质透镜植入术矫正远视早期是安全有效的,但其可预测性有待提高,远期疗效还需进一步随访观察。Objective To explore the early safety and efficacy of femtosecond laser-assisted intrastromal lenticular implantation(FILI)in correcting hyperopia.Methods A prospective study was conducted.Seven hyperopic patients(9 eyes)were performed with FILI,and the follow-up period was 6 months.The uncorrected distance visual acuity(UDVA),uncorrected near visual acuity(UNVA),best corrected distance visual acuity,spherical equivalent(SE)refraction,intraocular pressure,corneal curvature,corneal general condition and nerve growth were observed after operation.Results All the patients were operated successfully,but unfortunately,corneal rejection occurred in only one patient(1 eye)at 4 months after operation.Corneal stromal edema disappeared in 1 month and 3 months after operation.Six months after surgery,the lens was completely fused with the surrounding tissue,and the boundary could not be identified.The UNVA,UDVA and SE were improved at all time points after operation,and K1,K2 and central corneal thickness on the anterior corneal surface were increased significantly compared with those before operation.There was no significant difference in Km of the posterior corneal surface and intraocular pressure between pre-operation and post-operation(both P>0.05).The OCT(except for 1 eye with rejection)showed smooth corneal surface,transparent and well-located lenticules.The confocal examination showed corneal edema and activated corneal stromal cells in both lenticules tissue and corneal stromal layer 1 week after surgery.Over time,corneal edema subsided,stromal cells gradually remained stationary and nerve fibers were visible.Conclusion The FILI is safe and effective in the early stage in correction of hyperopia,but the predictability needs to be improved,and the long-term effect needs further follow-up observation.

关 键 词：飞秒激光辅助的角膜基质透镜植入术 远视 角膜曲率 

分 类 号：R778.1[医药卫生—眼科]