深板层角膜移植术中实时相干光层析成像术的初步应用研究  

Application of intraoperative optical coherence tomography in deep lamellar keratoplasty

作　　者：王欣 亓晓琳 王妙霖 苏敏 李素霞 史伟云 高华 Wang Xin;Qi Xiaolin;Wang Miaolin;Su Min;Li Suxia;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9期723-729,共7页Chinese Journal of Ophthalmology

基　　金：国家自然科学基金(81870639,81530027);泰山学者计划(201812150)。

摘　　要：目的评估术中实时相干光层析成像术(iOCT)在大气泡法辅助暴露角膜后弹力层的前部深板层角膜移植术(DALK)中的应用价值。方法回顾性病例系列研究。收集2020年1月至2021年8月在山东第一医科大学附属眼科医院接受大气泡法辅助暴露角膜后弹力层DALK的92例(92只眼)单眼角膜基质疾病患者临床资料,男性53例(53只眼),女性39例(39只眼);年龄为(53.2±16.0)岁。所有患眼术中均在初步剥除角膜病灶后行iOCT扫描,确定进针注气位置及深度;完整剥除角膜病灶后,观察角膜植床后弹力层完整性;缝合角膜植片后,观察角膜植片与植床贴附情况,角膜植床有无皱褶。记录根据iOCT扫描结果确定手术操作的情况、术中角膜植床后弹力层穿孔情况、术后角膜及角膜植床厚度、术后视力、术后角膜散光度数等。结果在92只眼中,62只眼(67.4%)iOCT扫描结果显示角膜植床厚度约为1/2角膜厚度,且各方位厚度较为均匀,从角膜植床中央进针注入无菌空气,分离角膜植床后弹力层与基质层;30只眼(32.6%)因iOCT扫描结果显示角膜植床各方位厚度不均匀,故注气针头须避开角膜植床中央变薄区域,在角膜植床旁中央进针注入无菌空气。在iOCT扫描指导下,89只眼(96.7%)术中未发生角膜植床后弹力层穿孔,3只眼(3.3%)在手工剖切角膜植床过程中发生穿孔。iOCT扫描发现并引导平复角膜植床中央直径5 mm区域后弹力层皱褶20只眼。术后角膜总厚度为(578.95±108.26)μm,角膜植床厚度为(36.06±23.11)μm。术后6个月最佳矫正视力为0.57±0.25(logMAR视力),优于术前最佳矫正视力1.61±1.27(P<0.001)。术后6个月角膜散光度数为(2.72±2.44)D。结论在大气泡法辅助暴露角膜后弹力层的DALK术中,应用iOCT扫描可为术者提供安全引导,以采取正确的手术操作,降低角膜植床后弹力层穿孔风险,减少角膜植床皱褶,利于角膜层间贴合,从而提高患者的术后�Objective To evaluate the clinical application value of intraoperative optical coherence tomography(iOCT)in deep anterior lamellar keratoplasty(DALK)using the big-bubble technique to bare Descemet′s membrane.Methods Retrospective case series.Clinical data of 92 patients(92 eyes)with monocular stromal corneal diseases who underwent big-bubble DALK in the Eye Hospital of Shandong First Medical University from January 2020 to August 2021 were collected.There were 53 males and 39 females.The average age was(53.2±16.0)years old.All patients underwent iOCT scanning to determine the location and depth of the injection needle after initial removal of the corneal lesion,to observe the integrity of the recipient bed,Descemet′s membrane,after complete lesion removal,and to observe the adhesion between the corneal graft and the recipient bed and check folds on the recipient bed after suturing of the corneal graft.The intraoperative perforation of Descemet′s membrane,postoperative thickness of the cornea and the recipient bed,visual acuity,and corneal astigmatism were recorded.Results By iOCT,the thickness of the recipient bed was found to be about 1/2 of the corneal thickness and relatively uniform in all directions in 62 eyes(67.4%),so the sterile air was injected from the center of the recipient bed to separate it from the stromal layer.In 30 eyes(32.6%)with an uneven thickness of the recipient bed,the sterile air was injected from the paracentral area of the recipient bed.Under the guidance of iOCT scanning,89 eyes(96.7%)did not experience any perforation of Descemet′s membrane during surgery.The Descemet′s membrane folds in the central 5-mm area of the recipient bed was observed and flattened in 20 eyes with the assistance of iOCT scanning.The postoperative corneal thickness was(578.95±108.26)μm,and the recipient bed thickness was(36.06±23.11)μm.The best corrected visual acuity of all patients at 6 months after surgery was 0.57±0.25 logMAR,which was significantly better than that before surgery(1.61±1.27

关 键 词：角膜疾病 角膜移植 体层摄影术 光学相干 

分 类 号：R779.65[医药卫生—眼科]