角膜基质透镜移植治疗LASIK术后继发性圆锥角膜的长期临床观察  

Tuck-in lamellar keratoplasty with a corneal lenticule for the treatment of post-LASIK ectasia:a long-term observational study

作　　者：狄宇 李莹[1] 姜洋[1] DI Yu;LI Ying;JIANG Yang(Department ofOphthalmology Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院&北京协和医学院,北京协和医院眼科,北京100730

出　　处：《中国科学：生命科学》2022年第7期1101-1108,共8页Scientia Sinica(Vitae)

摘　　要：准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后继发圆锥角膜是一种非常严重的并发症,角膜接触镜、角膜基质环植入术、角膜交联术及穿透性角膜移植术均可对其进行治疗,然而上述治疗方法有不同的适应证和禁忌证.本研究对应用全飞秒激光小切口角膜基质透镜取出术(small incision lenticule extraction,SMILE)提供的角膜基质透镜进行填塞式板层角膜移植术(tuck-in lamellar keratoplasty,TILK)以治疗LASIK术后圆锥角膜,术后平均随诊42个月,结果提示在角膜厚度方面,术后早期角膜最薄点厚度和角膜中央厚度均较术前显著提高,随着角膜水肿逐渐消退,角膜厚度逐渐下降,末诊处于稳定状态,而角膜基质透镜厚度在术后各随访时间点无显著改变.在角膜曲率方面,术后早期最小角膜曲率(Kmin)和平均角膜曲率(AveK)均较术前显著增高,最大角膜曲率(Kmax)较术前相比稳定性欠佳,但长期观察Kmin,Kmax及AveK与术前相比无明显统计学差异,末诊处于稳定状态.角膜表面非对称性指数(surface asymmetry index,SAI)在术后各随访时间点无显著改变.本文证实TILK治疗LASIK术后圆锥角膜具有一定可行性,且长期观察结果提示其具有较好的安全性及有效性,特别是对于角膜最薄点厚度低于400μm的圆锥角膜,其为LASIK术后圆锥角膜的治疗提供了新选择.Post-laser in situ keratomileusis(LASIK)ectasia is a serious complication that can be treated with contact lens,intrastromal corneal ring,corneal collagen crosslinking,and penetrating keratoplasty.However,these treatments have various indications and contraindications.In this study,tuck-in lamellar keratoplasty(TILK)was performed on corneal lenticules through small incision lenticule extraction(SMILE)to treat post-LASIK ectasia.After 42 months of follow-up,the thinnest point of the corneal thickness and the central corneal thickness in the early postoperative period were observed to be significantly higher than those preoperatively.As the corneal edema gradually subsided,the corneal thickness progressively decreased,and it was stable at the final visit.However,no significant change was found in the thickness of the corneal lenticule at each follow-up time point.Regarding keratometry,Kmin and AveK were significantly higher in the early postoperative period than preoperatively,and Kmax was not stable in the early postoperative period.However,no significant differences were observed in Kmin,Kmax,and AveK during long-term observation compared with those before surgery,and the values were stable at the final visit.The corneal surface asymmetry index did not change significantly at all follow-up time points.The results indicated that TILK with corneal lenticule is safe and effective in the long-term observation,and it might be an alternative surgical approach in the treatment of post-LASIK ectasia,especially for severe cases with a corneal thickness of<400μm.

关 键 词：继发圆锥角膜 SMILE 角膜基质透镜 TILK 

分 类 号：R779.63[医药卫生—眼科]