Rich L F
Department of Ophthalmology, Casey Eye Institute, Oregon Health Sciences University, Portland, USA.
Trans Am Ophthalmol Soc. 1999;97:771-814.
To investigate whether applications of current technology, such as cryolathe and excimer laser, might improve outcomes and increase use of lamellar keratoplasty.
Six studies were performed, beginning with animals and progressing to human subjects. The first study compared cryolathed with hand-dissected rabbit corneas to ascertain which created a smoother donor interface. The second animal pilot study was done to determine whether thickness of donor cornea resection could be accurately predicted with the cryolathe. A prospective animal trial was then undertaken to compare lamellar keratoplasty outcomes using cryolathed versus hand-dissected tissue. The fourth work extrapolated previous animal findings to lamellar keratoplasty in human disease. Finally, two ongoing studies are described. The first explores the possibility of sutureless lamellar keratoplasty. The second utilizes the excimer laser to dissect the recipient stromal bed.
The initial animal pilot study demonstrated a clearer stromal surface in cryolathed versus hand-dissected corneal tissue. The second pilot showed that plano-powered donor tissue could be generated to predetermined thickness. The prospective animal trial revealed that clear grafts of intended thickness could be obtained with cryolathing. Human studies suggested that lamellar keratoplasty using cryolathe-prepared donor tissue may offer superior results to free-hand dissection. Finally, one ongoing study indicates that sutureless lamellar keratoplasty is untenable, and the other shows that clear grafts can be obtained by combining cryolathed donor tissue with recipient photoablation.
This body of work demonstrates that use of new lamellar keratoplasty technology may offer expanded scope and better outcomes than traditional lamellar keratoplasty techniques.
探讨应用当前技术，如冷冻板层角膜切削术和准分子激光，是否可能改善手术效果并增加板层角膜移植术的应用。
进行了六项研究，从动物研究开始，逐步开展人体研究。第一项研究比较了冷冻板层切削的兔角膜和手工剖切的兔角膜，以确定哪种方式能形成更光滑的供体界面。第二项动物预试验旨在确定使用冷冻板层切削术能否准确预测供体角膜切除的厚度。随后进行了一项前瞻性动物试验，比较使用冷冻板层切削组织与手工剖切组织的板层角膜移植术效果。第四项研究将先前动物研究的结果外推至人类疾病的板层角膜移植术。最后描述了两项正在进行的研究。第一项研究探索无缝合板层角膜移植术的可能性。第二项研究利用准分子激光剖切受体基质床。
最初的动物预试验表明，与手工剖切的角膜组织相比，冷冻板层切削的角膜组织基质表面更清晰。第二项预试验表明，可以制作出屈光度为零的供体组织，使其达到预定厚度。前瞻性动物试验显示，使用冷冻板层切削术可获得预期厚度的透明植片。人体研究表明，使用冷冻板层切削制备的供体组织进行板层角膜移植术可能比徒手剖切效果更好。最后，一项正在进行的研究表明无缝合板层角膜移植术不可行，另一项研究表明，将冷冻板层切削的供体组织与受体光消融相结合可获得透明植片。
这一系列研究表明，与传统板层角膜移植技术相比，使用新的板层角膜移植技术可能具有更广阔的应用范围和更好的手术效果。
