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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摘要目的：观察分析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的疗效及安全性。方法：回顾性系列病例研究。选择2015年1月至2017年9月于山东省眼科医院接受飞秒激光辅助大泡技术深板层角膜移植治疗的角膜基质层营养不良患者16例（19眼），术后随访1年以上且随访资料完整。其中包括颗粒状角膜营养不良6眼，斑块状角膜营养不良8眼，格子状角膜营养不良5眼。随访12～32（17.1±1.3）个月，观察患者术前及随访时裸眼视力（UCVA）、最佳矫正视力（BCVA）、眼压、角膜散光度、等效球镜度（SE）、平均角膜曲率、角膜内皮细胞密度、植片排斥反应、术后并发症及复发情况等。结果：所有患者手术均顺利完成。术前BCVA为光感～0.25，其中小于0.10 者10眼，0.10～0.25者9眼；末次随诊时为0.12～0.80，其中0.10～0.25者5眼，0.30～0.40者5眼， ≥0.50者9眼。视力（标准对数视力表）提高2.00～8.00（5.3±1.8）行。术前角膜散光0.50～2.60 （1.62±0.57）D，末次随诊时1.30～4.20（2.56±0.87）D；术前SE -4.00～+1.25（-1.29±1.86）D，末次随诊时-7.50～+8.00（-0.48±3.84）D；术前角膜曲率42.78～45.38（44.24±0.95）D，末次随诊时 39.20～45.06（43.12±2.22）D；术后12个月时的角膜内皮细胞较术后1个月时的角膜内皮细胞丢失率为8%。末次随诊时测量植床厚度为20～39（29.4±6.1）μm。术后并发症为1眼术中植床微小穿孔， 1眼术后首日可见植片、植床层间少量积血，处理后病情稳定。所有患者末次随诊时均可见角膜植片与植床紧密贴合且透明，未见松线、层间积液及植片免疫排斥反应，未见营养不良病变复发。结论：飞秒激光辅助大泡技术深板层角膜移植是治疗角膜基质层营养不良的安全方法，术后散光较少，视力较好。

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关键词 ：飞秒激光, 深板层角膜移植术, 大泡技术, 角膜基质层营养不良

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

收稿日期: 2019-10-10

基金资助:国家自然科学基金（81870639、81570821）；山东第一医科大学学术提升计划（2019RC009）

通讯作者: 高华（ORCID：0000-0002-1326-6946），Email：gaohua100@126.com

引用本文:

戴鹏飞1，2 亓晓琳1 刘明娜1 李翔1 李颖2 高华1. 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[J]. 中华眼视光学与视觉科学杂志, 2020, 22(7): 485-491. Pengfei Dai1, 2, Xiaolin Qi1,Mingna Liu1,Xiang Li1,Ying Li2,Hua Gao1. Clinical Outcomes of the Femtosecond Laser-Assisted Big-Bubble Technique for Deep Lamellar Keratoplasty to Treat Corneal Stromal Dystrophy. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(7): 485-491. DOI: 10.3760/cma.j.cn115909-20191010-00275

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https://www.cjoovs.com/CN/10.3760/cma.j.cn115909-20191010-00275 或 https://www.cjoovs.com/CN/Y2020/V22/I7/485

[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.