Behrens A, Seitz B, Langenbucher A, Kus M M, Küchle M, Naumann G O
Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany.
J Cataract Refract Surg. 2000 Nov;26(11):1605-11. doi: 10.1016/s0886-3350(00)00717-3.
To compare the lens opacity formation after penetrating keratoplasty (PKP) using nonmechanical excimer laser corneal trephination and mechanical motor trephination. SETTTING: University Eye Clinic, University of Erlangen-Nürnberg, Erlangen, Germany.
Ninety-six patients with keratoconus (96 eyes) and clear crystalline lenses were randomly assigned to the nonmechanical trephination (NMT) group (n = 46; 35 men; mean age 38.2 years +/- 10.8 [SD]) or the mechanical trephination (MT) group (n = 50; 35 men; mean age 34.4 +/- 9.0 years). Suturing and postoperative treatment were identical. Dilated pupil biomicroscopy and slitlamp lens photography were performed preoperatively and postoperatively at 3 month intervals. Opacities were identified as cortical, nuclear, and posterior subcapsular and graded from 1 (mild) to 3 (severe).
Mean follow-up in the NMT/MT group was 3.2 +/- 1.3 years/3.4 +/- 1.1 years. Overall, incident opacities appeared in 23.9%/32.0% of eyes (4.3%/6.0% cortical; 19. 6%/26.0% posterior subcapsular; 0%/0% nuclear) (P =.833). All cortical opacities in both groups were grade 1; posterior subcapsular opacities were grade 1 in 66.6%/61.5% of eyes and grade 2 in 22.2%/30.8% of eyes. One patient in each group presented grade 3 posterior subcapsular opacities. No differences between trephination methods were seen in a 5 year Kaplan-Meier cumulative risk of lens opacity formation (P =.763 cortical, P =.530 posterior subcapsular).
In addition to its optical advantages, nonmechanical corneal trephination appears to have no adverse impact on cataract formation after PKP for keratoconus.
比较使用非机械准分子激光角膜环切术和机械动力环切术进行穿透性角膜移植术（PKP）后晶状体混浊的形成情况。地点：德国埃尔朗根 - 纽伦堡大学眼科诊所。
96例圆锥角膜患者（96只眼）且晶状体透明，被随机分配至非机械环切术（NMT）组（n = 46；35名男性；平均年龄38.2岁±10.8[标准差]）或机械环切术（MT）组（n = 50；35名男性；平均年龄34.4±9.0岁）。缝合及术后治疗相同。术前及术后每隔3个月进行散瞳生物显微镜检查和裂隙灯晶状体摄影。混浊分为皮质性、核性和后囊下混浊，并从1级（轻度）到3级（重度）进行分级。
NMT/MT组的平均随访时间为3.2±1.3年/3.4±1.1年。总体而言，23.9%/32.0%的眼出现了新发混浊（4.3%/6.0%为皮质性；19.6%/26.0%为后囊下；0%/0%为核性）（P = 0.833）。两组所有皮质性混浊均为1级；后囊下混浊在66.6%/61.5%的眼中为1级，在22.2%/30.8%的眼中为2级。每组各有1例患者出现3级后囊下混浊。在5年的Kaplan - Meier晶状体混浊形成累积风险方面，环切术方法之间未见差异（皮质性P = 0.763，后囊下P = 0.530）。
除了其光学优势外，非机械角膜环切术似乎对圆锥角膜PKP术后白内障的形成没有不利影响。
