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

doi:10.3760/cma.j.cn115909-20191010-00275

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Abstract 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 with the cell count one month after surgery. The thickness of the recipient bed was 20-39(29.4±6.1)μm at the last follow-up evaluation. Micro-perforations in the recipient bed and a small amount of blood between the graft and the recipient bed were discovered in one eye. At the last follow-up assessment, the connections between the corneal grafts and the recipient beds of all of the patients were tight and transparent. No cases of visible loose lines, interstitial fluids, graft rejection or recurring dystrophy were present. Conclusions: Femtosecond laser-assisted big-bubble DLK is a safe procedure to treat corneal stromal dystrophy. Postoperative astigmatism is minimal, and general visual acuity is satisfactory.

Key words： femtosecond laser deep lamellar keratoplasty big-bubble technique corneal stromal dystrophy

Received: 10 October 2019

Fund:National Natural Science Foundation of China (81870639, 81570821); Academic Promotion Program of Shandong First Medical University (2019RC009)

Corresponding Authors: Hua Gao, Shandong First Medical University & Shandong Academy of Medical Sciences, Shandong Institute of Ophthalmology, Shandong Eye Hospital, Jinan 250021, China (Email: gaohua100@126.com)

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[1]	谢立信. 临床角膜病学. 北京: 人民卫生出版社, 2014: 94-100.
[2]	Borderie VM, Sandali O, Bullet J, et al. Long-term results of deep anterior lamellar versus penetrating keratoplasty. Ophthalmology, 2012, 119(2): 249-255. DOI: 10.1016/j.ophtha.2011.07.057.
[3]	高华. 前部深板层角膜移植术值得关注和存在争议的问题. 中华眼科杂志, 2017, 53(3): 164-166. DOI: 10.3760/cma.j.issn. 0412-4081.2017.03.002.
[4]	Mosca L, Fasciani R, Tamburelli C, et al. Femtosecond laser-assisted lamellar keratoplasty: Early results. Cornea, 2008, 27(6): 668-672. DOI: 1097/ICO.0b013e31816736b1.
[5]	高华, 贾艳妮, 丁刚, 等. 暴露后弹力层的深板层角膜移植治疗深层化脓性角膜炎的初步临床观察. 中华眼科杂志, 2013, 49(10): 884-889. DOI: 10.3760/cma.j.issn.0412-4081.2013.10. 005.
[6]	高华, 贾艳妮, 宋鹏, 等. 改良大泡技术辅助的暴露后弹力层深板层角膜移植术(附视频). 中华移植杂志(电子版), 2012, 6(3): 181-186. DOI: 10.3877/cma.j.issn.1647-3903.2012.03. 002.
[7]	Gao H, Song P, Echegaray JJ, et al. Big bubble deep anterior lamellar keratoplasty for management of deep fungal keratitis. J Ophthalmol, 2014, 2014: 209759. DOI: 10.1155/2014/209759.
[8]	Reddy JC, Rapuano CJ, Nagra PK, et al. Excimer laser phototherapeutic keratectomy in eyes with corneal stromal dystrophies with and without a corneal graft. Am J Ophthalmol, 2013, 155(6): 1111-1118.e2. DOI: 10.1016/j.ajo.2012.12.016.
[9]	Reddy JC. Deep anterior lamellar keratoplasty for the treatment of stromal corneal dystrophies. Cornea, 2013, 32(8): e184-185. DOI: 10.1097/ICO.0b013e318292a7d2.
[10]	Aggarwal S, Peck T, Golen J, et al. Macular corneal dystrophy: A review. Surv Ophthalmol, 2018, 63(5): 609-617. DOI: 10.1016/j.survophthal.2018.03.004.
[11]	Wang X, Liu T, Zhang S, et al. Outcomes of wound dehiscence after penetrating keratoplasty and lamellar keratoplasty. J Ophthalmol, 2018, 2018: 1435389. DOI: 10.1155/2018/ 1435389.
[12]	Almousa R, Samaras KE, Khan S, et al. Femtosecond laser-assisted lamellar keratoplasty (FSLK) for anterior corneal stromal diseases. Int Ophthalmol, 2014, 34(1): 49-58. DOI:10.1007/s10792-013-9794-7.
[13]	Bonfadini G, Moreira H, Jun AS, et al. Modified femtosecond laser-assisted sutureless anterior lamellar keratoplasty. Cornea, 2013, 32(4): 533-537. DOI: 10.1097/ICO.0b013e31826e828c.
[14]	Pashtaev A, Malyugin B. Femtosecond laser-assisted anterior lamellar keratoplasty for keratoconus. Acta Ophthalmologica, 2014, 92(253): 4235. DOI: 10.1111/j.1755-3768.2014.4235.x.
[15]	Reinhart WJ, Musch DC, Jacobs DS, et al. Deep anterior lamellar keratoplasty as an alternative to penetrating keratoplasty a report by the american academy of ophthalmology. Ophthalmology, 2011, 118(1): 209-218. DOI: 10.1016/j.ophtha.2010.11.002.
[16]	Kubaloglu A, Coskun E, Sari ES, et al. Comparison of astigmatic keratotomy results in deep anterior lamellar keratoplasty and penetrating keratoplasty in keratoconus. Am J Ophthalmol, 2011, 151(4): 637-643. DOI: 10.1016/j.ajo.2010.10.029.
[17]	张霞, 蒋华, 路振莉,等. 穿透性角膜移植屈光控制的临床研究. 眼科新进展, 2006, 26(3): 206-207. DOI: 10.3969/j.issn.1003- 5141.2006.03.013.
[18]	Spadea L, Cifariello F, Bianco G, et al. Long-term results of penetrating keratoplasty using a single or double running suture technique. Graefes Arch Clin Exp Ophthalmol, 2002, 240(5): 415-419. DOI: 10.1007/s00417-002-0444-4.
[19]	Watson SL, Ramsay A, Dart JK, et al. Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus. Ophthalmology, 2004, 111(9): 1676-1682. DOI: 10.1016/j.ophtha.2004.02.010.
[20]	胥晓涵, 刘丽梅, 史伟云, 等. 圆锥角膜行板层角膜移植术和穿透性角膜移植术后屈光状态的比较. 临床眼科杂志, 2013, 21(1): 5-8. DOI: 10.3969/j.issn.1006-8422.2013.01.002.
[21]	Ardjomand N, Hau S, McAlister JC, et al. Quality of vision and graft thickness in deep anterior lamellar and penetrating corneal allografts. Am J Ophthalmol, 2007, 143(2): 228-235. DOI: 10.1016/j.ajo.2006.10.043.
[22]	Abdelkader A, Kaufman HE. Descemetic versus pre-descemetic lamellar keratoplasty: Clinical and confocal study. Cornea, 2011, 30(11): 1244-1252. DOI: 10.1097/ICO.0b013e318219bc1a.
[23]	Tan D T, Dart JK, Holland EJ, et al. Corneal transplantation. Lancet, 2012, 379(9827): 1749-1761. DOI: 10.1016/S0140- 6736(12)60437-1.
[24]	Liu T, Zhang J, Sun D, et al. Comparative study of corneal endothelial cell damage after femtosecond laser assisted deep stromal dissection. Biomed Res Int, 2014, 2014(7): 731565. DOI: 10.1155/2014/731565.
[25]	陈敏, 马玲, 杜显丽. PTK治疗浅层角膜病变复发特点分析. 全国角膜屈光手术大会. 2012.