异体角膜基质透镜植入联合角膜胶原交联术治疗圆锥角膜的短期临床观察  

Short term clinical observation of keratoconus treated with stromal lenticule addition keratoplasty combined with corneal collagen cross-linking

作　　者：刘佳[1] 申笛 孙西宇 周堃 王亚妮[1] 韦伟 Liu Jia;Shen Di;Sun Xiyu;Zhou Kun;Wang Yani;Wei Wei(Ophthalmological Department of the First Affiliated Hospital of Northwestern University and Xi′an No.1 Hospital,Shaanxi Ophthalmological Institute,Shaanxi Key Laboratory of Ophthalmology,Clinical Research Center for Ophthalmology Diseases of Shaanxi Province,Xi′an 710002,China)

机构地区：[1]西北大学附属第一医院眼科、西安市第一医院眼科、陕西省眼科研究所、陕西省眼科学重点实验室、陕西省眼科疾病临床医学研究中心,西安710002

出　　处：《中华眼科杂志》2023年第10期832-837,共6页Chinese Journal of Ophthalmology

基　　金：陕西省科技厅自然科学基金(2022SF-404);陕西省自然科学基础研究计划面上项目(2021JM-593)。

摘　　要：目的探讨飞秒激光辅助的异体角膜基质透镜植入术(SLAK)联合角膜胶原交联术(CXL)治疗中晚期圆锥角膜的疗效。方法回顾性病例系列研究。收集2020年9月至2022年6月于西安市第一医院激光近视治疗中心行飞秒激光辅助的SLAK联合CXL的圆锥角膜病例资料23例(24只眼),其中男性16例,女性7例,年龄(23.69±5.18)岁。记录供体角膜基质透镜厚度、屈光度数、直径;记录患者术前及术后1、3、6个月的裸眼视力、最佳矫正视力(BCVA)、屈光度数;记录患者Sirius三维眼前节分析仪测量的角膜前表面平坦曲率(Kf)和陡峭曲率(Ks)及两者的差值ΔK,以及角膜中央厚度(CCT)及角膜中央直径6 mm圆形区域的总高阶像差、彗差、球差和三叶草差。结果供体角膜基质透镜厚度、近视球镜度数及柱镜度数分别为(103.50±15.78)μm、(4.77±1.34)D和(-0.19±0.24)D。23例(24只眼)圆锥角膜患者飞秒激光辅助的SLAK联合CXL术后6个月CCT为(454.83±50.01)μm,高于术前的(384.92±35.45)μm,差异有统计学意义(P<0.05)。术后6个月UCVA为1.41±0.32,低于术前的1.11±0.33;术后6个月近视球镜度数为(15.73±7.89)D,高于术前的(12.08±5.99)D;术后6个月角膜前表面Kf和Ks分别为(56.82±4.76)和(61.00±4.70)D,高于术前的(53.55±4.95)和(58.65±5.10)D;差异均有统计学意义(P<0.05)。术前与术后6个月BCVA及柱镜度数、ΔK的差异均无统计学意义(P>0.05),角膜中央直径6 mm圆形区域的各高阶像差的差异亦无统计学意义(P>0.05)。且本研究中所有术眼随访期内均未见角膜基质透镜褶皱、融解及移位,无角膜混浊或免疫排斥反应。结论飞秒激光辅助的SLAK联合CXL可显著增加圆锥角膜眼的角膜厚度,具有良好的有效性;患者术后半年视力和像差无明显变化,未见不良反应,手术具有一定的安全性。Objective To investigate the efficacy of Femtosecond laser-assisted stromal lenticule addition keratoplasty(SLAK)combined with corneal collagen cross-linking(CXL)in the treatment of middle and advanced Keratoconus.Methods It was a retrospective case series study.Data of 23 cases(24 eyes)of keratoconus treated with femtosecond laser-assisted SLAK combined with CXL in Laser Vision Centre of Xi′an No.1 Hospital from September 2020 to June 2022 were collected,including 16 males and 7 females,aged(23.69±5.18)years.The thickness,diopter number and diameter of the donor corneal stromal lens were assessed.uncorrected visual acuity(UCVA),best corrected visual acuity(BCVA),and diopter were recorded before and 1,3,and 6 months after surgery.Sirius 3D fault corneal topography instrument to measure flat simulated keratometry(Kf),steep simulated keratometry(Ks)and the difference between them(ΔK),as well as central corneal thickness(CCT)and corneal high-order aberration.Results Six months after surgery,CCT(454.83±50.01)μm were significantly higher than before(384.92±35.45)μm(P<0.05).Six months after surgery,UCVA(1.41±0.32)was significantly lower than before(1.11±0.33)(P<0.05).Six months after surgery,spherical diopter[(-15.73±7.89)D],Kf[(56.82±4.76)D]and Ks[(61.00±4.70)D]were significantly higher than before[(-12.08±5.99)D,(53.55±4.95)D,(58.65±5.10)D](P<0.05).There was no significant difference in BCVA,column mirror degree and higher order aberrations before and 6 months after surgery(P>0.05).No corneal stromal lens folds,melting and displacement were observed in all eyes during the follow-up period,and no corneal opacity or immune rejection was observed.Conclusions femtosecond laser-assisted SLAK combined with CXL can significantly increase the corneal thickness of keratoconus and has good effectiveness.In addition,six months of postoperative follow-up of patients showed no significant changes in BCVA and high-order aberrations in the 6 mm central diameter of the cornea,and no postoperative adverse reaction wer

关 键 词：圆锥角膜 角膜基质 角膜移植 胶原 交联试剂 激光 飞秒 

分 类 号：R779.6[医药卫生—眼科]