飞秒激光辅助的微创板层角膜移植术治疗完成期圆锥角膜的安全性和有效性  

Femtosecond laser-assisted minimally invasive lamellar keratoplasty for advanced keratoconus

作　　者：刘明娜 李娜 田歌 陈彤 林越 李素霞 亓晓琳 史伟云 高华 Liu Mingna;Li Na;Tian Ge;Chen Tong;Lin Yue;Li Suxia;Qi Xiaolin;Shi Weiyun;Gao Hua(Eye Institute of Shandong First Medical University,Eye Hospital of Shandong First Medical University(Shandong Eye Hospital),State Key Laboratory Cultivation Base,Shandong Provincial Key Laboratory of Ophthalmology,School of Ophthalmology,Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属眼科研究所、山东第一医科大学附属眼科医院(山东省眼科医院)山东省眼科学重点实验室-省部共建国家重点实验室培育基地、山东第一医科大学眼科学院,济南250021

出　　处：《中华眼科杂志》2023年第4期288-294,共7页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(82070923,81870639);山东省重点研发计划(重大科技创新工程)(2022CXGC010505);泰山学者计划(201812150,20150215);山东省自然科学基金(ZR2020MH171);山东第一医科大学学术促进计划(2019RC009)。

摘　　要：目的评估飞秒激光辅助的微创板层角膜移植术(FL-MILK)治疗完成期圆锥角膜的初步安全性和有效性。方法病例系列研究。前瞻性连续纳入2017年8月至2020年4月于山东省眼科医院行FL-MILK的完成期圆锥角膜患者。采用飞秒激光制作受体角膜基质囊袋和供体板层角膜。将供体板层角膜折叠植入受体角膜基质囊袋后展开。观察指标包括最佳矫正视力、角膜前表面3 mm平均曲率、角膜中央前后表面高度、中央角膜厚度、角膜形变幅度比值、硬度指数和角膜内皮细胞密度。术后1、12、24个月进行随访。结果共纳入患者33例(35只眼),其中男性26例,女性7例,年龄为(20.34±5.24)岁。33例(35只眼)和25例(27只眼)分别完成术后12和24个月的随访。随访期间所有患者均未出现感染、上皮植入、同种异体角膜移植免疫排斥等并发症。与术前相比,术后患者的角膜中央前表面高度(P<0.001)及角膜前表面3 mm平均曲率均显著降低(P<0.05),中央角膜厚度显著增厚(P<0.001),角膜生物力学强度显著改善。术后24个月,角膜形变幅度比值由术前的1.39±0.14降低至1.21±0.10(P<0.001),角膜硬度指数从术前的41.49±11.47增加至88.41±18.17(P<0.001);与术前相比,术后BCVA、角膜中央后表面高度、等效球镜度数和角膜内皮细胞密度的差异均无统计学意义(均P>0.05)。结论飞秒激光辅助的微创板层角膜移植术治疗完成期圆锥角膜安全有效,该手术将为圆锥角膜提供一种新的安全的治疗方法。Objective To evaluate the initial safety and efficacy of femtosecond laser-assisted minimally invasive lamellar keratoplasty(FL-MILK)for advanced keratoconus.Methods It was a case series study.Patients with advanced keratoconus who underwent FL-MILK between August 2017 and April 2020 at Shandong Eye Hospital were prospectively included.The femtosecond laser was used to create an intrastromal pocket in the recipient cornea and a lamellar cornea in the donor.The lamellar cornea was then gently inserted into the intrastromal pocket through the incision and flattened.Clinical measurements included best-corrected visual acuity,3-mm anterior corneal mean keratometry,anterior and posterior central corneal elevation,central corneal thickness,corneal biomechanics,and endothelial cell density.The follow-up was conducted at 1 month,12 months,and 24 months after the operation.Results There were 33 patients(35 eyes)in the study.Twenty-six patients were male and 7 patients were female.The mean age was(20.34±5.24)years old.All patients completed 12 months of follow-up,and 25 patients(27 eyes)completed 24 months of follow-up.No epithelial ingrowth,infection,or allogeneic rejection was observed.Compared with the preoperative data,the anterior central corneal elevation significantly decreased(P<0.001),the mean keratometry significantly decreased(P<0.05),and the central corneal thickness significantly increased(P<0.001).The corneal biomechanical strength was significantly improved,with the deformation amplitude ratio at 2.0 mm decreasing from 1.39±0.14 preoperatively to 1.21±0.10 at 24 months postoperatively(P<0.001)and the stiffness parameter at the first applanation increasing from 41.49±11.47 preoperatively to 88.41±18.17 at 24 months postoperatively(P<0.001).There were no significant changes in the mean best-corrected visual acuity,posterior corneal elevation,mean spherical equivalent,and endothelial cell density(all P>0.05).Conclusions FL-MILK may be a feasible option for advanced keratoconus.This procedure may provide a

关 键 词：圆锥角膜 角膜移植 最小侵入性外科手术 激光 飞秒 有效性研究(主题) 

分 类 号：R779.65[医药卫生—眼科]