飞秒激光辅助大泡技术深板层角膜移植治疗角膜基质层营养不良  

Clinical Outcomes of the Femtosecond Laser-Assisted Big-Bubble Technique for Deep Lamellar Keratoplasty to Treat Corneal Stromal Dystrophy

作　　者：戴鹏飞 亓晓琳[1] 刘明娜 李翔 李颖 高华[1] Pengfei Dai;Xiaolin Qi;Mingna Liu;Xiang Li;Ying Li;Hua Gao(Shandong First Medical University&Shandong Academy of Medical Sciences,Shandong Institute of Ophthalmology,Shandong Eye Hospital,Jinan 250021,China;Xi'an No.4 Hospital,Xi'an 710004,Chin)

机构地区：[1]山东第一医科大学(山东省医学科学院)山东省眼科研究所,山东第一医科大学附属,眼科医院(山东省眼科医院),济南250021 [2]西安市第四医院,710004

出　　处：《中华眼视光学与视觉科学杂志》2020年第7期485-491,共7页Chinese Journal Of Optometry Ophthalmology And Visual Science

基　　金：国家自然科学基金(81870639、81570821);山东第一医科大学学术提升计划(2019RC009)。

摘　　要：目的:观察分析飞秒激光辅助大泡技术深板层角膜移植治疗角膜基质层营养不良的疗效及安全性。方法:回顾性系列病例研究。选择2015年1月至2017年9月于山东省眼科医院接受飞秒激光辅助大泡技术深板层角膜移植治疗的角膜基质层营养不良患者16例(19眼),术后随访1年以上且随访资料完整。其中包括颗粒状角膜营养不良6眼,斑块状角膜营养不良8眼,格子状角膜营养不良5眼。随访12~32(17.1±1.3)个月,观察患者术前及随访时裸眼视力(UCVA)、最佳矫正视力(BCVA)、眼压、角膜散光度、等效球镜度(SE)、平均角膜曲率、角膜内皮细胞密度、植片排斥反应、术后并发症及复发情况等。结果:所有患者手术均顺利完成。术前BCVA为光感~0.25,其中小于0.10者10眼,0.10~0.25者9眼;末次随诊时为0.12~0.80,其中0.10~0.25者5眼,0.30~0.40者5眼,≥0.50者9眼。视力(标准对数视力表)提高2.00~8.00(5.3±1.8)行。术前角膜散光0.50~2.60(1.62±0.57)D,末次随诊时1.30~4.20(2.56±0.87)D;术前SE-4.00^+1.25(-1.29±1.86)D,末次随诊时-7.50^+8.00(-0.48±3.84)D;术前角膜曲率42.78~45.38(44.24±0.95)D,末次随诊时39.20~45.06(43.12±2.22)D;术后12个月时的角膜内皮细胞较术后1个月时的角膜内皮细胞丢失率为8%。末次随诊时测量植床厚度为20~39(29.4±6.1)μm。术后并发症为1眼术中植床微小穿孔,1眼术后首日可见植片、植床层间少量积血,处理后病情稳定。所有患者末次随诊时均可见角膜植片与植床紧密贴合且透明,未见松线、层间积液及植片免疫排斥反应,未见营养不良病变复发。结论:飞秒激光辅助大泡技术深板层角膜移植是治疗角膜基质层营养不良的安全方法,术后散光较少,视力较好。Objective:To evaluate and analyze the efficacy and safety of using the femtosecond laser-assisted big-bubble technique for deep lamellar keratoplasty(DLK)to treat corneal stromal dystrophy.Methods:A total of 19 eyes with corneal stromal dystrophy from 16 patients who underwent femtosecond laser-assisted big-bubble DLK at Shandong Eye Hospital from January 2015 to September 2017,followed up more than 12 months and the case data completed were selected for this retrospective case study.Of these eyes,six were diagnosed with granular corneal dystrophy,eight with macular corneal dystrophy,and five with lattice corneal dystrophy.The following aspects of patient eye health were examined:Uncorrected vision,best corrected visual acuity,intraocular pressure,corneal astigmatism,spherical equivalent,mean corneal curvature,corneal endothelial density,graft rejection,postoperative complications,and disease recurrence.Results:All surgeries were performed successfully with subsequent follow-up visits for 12 to 32 months(17.1±1.3 months).The preoperative best corrected visual acuity among the eyes was between light perception and-0.25.There were 10 eyes that were less than 0.10 and nine eyes ranging from 0.10-0.25.At the last follow-up evaluation,best visual acuity ranged from 0.12-0.80,with five eyes between 0.1 and 0.25,five eyes between 0.30 and 0.40,and nine eyes equal to or above 0.50.Patient vision improved by two-to-eight lines(5.3±1.8 lines)on the Standard Logarithmic visual acuity Chart.Patient corneal astigmatism values ranged from 0.50 to 2.60 D(1.62±0.57 D)before surgery and from 1.30 to 4.2 D(2.56±0.87 D)at the last follow-up evaluation.Spherical equivalent of the patients ranged from-4.00 to+1.25 D(-1.29±1.86 D)before surgery and from-7.50-+8.00(-0.48±3.84)D at the last follow-up evaluation.Corneal curvature ranged from 42.78-45.38(44.24±0.95)D before surgery and from 39.20-45.06(43.12±2.22)D at the last follow-up evaluation.There was an 8%loss of corneal endothelial cells at 12 months after surgery compared

关 键 词：飞秒激光 深板层角膜移植术 大泡技术 角膜基质层营养不良 

分 类 号：R779.6[医药卫生—眼科]