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[飞秒激光散光角膜切开术:角膜移植术后高度散光的矫正]

[Astigmatic keratotomy with the femtosecond laser: correction of high astigmatisms after keratoplasty].

作者信息

Kook D, Bühren J, Klaproth O K, Bauch A S, Derhartunian V, Kohnen T

机构信息

Augenklinik der LMU, Klinikum der Universität München, München, Deutschland.

出版信息

Ophthalmologe. 2011 Feb;108(2):143-50. doi: 10.1007/s00347-010-2239-z.

Abstract

OBJECTIVE

The purpose of this study was to evaluate a novel technique for the correction of postoperative astigmatism after penetrating keratoplasty with the use of the femtosecond laser creating astigmatic keratotomies (femto-AK) in the scope of a retrospective case series.

METHODS

Clinical data of ten eyes of nine patients with high residual astigmatism after penetrating keratoplasty undergoing paired femto-AK using a 60-kHz femtosecond laser (IntraLase™, AMO) were analyzed. A new software algorithm was used to create paired arcuate cuts deep into the donor corneal button with different cut angles. Target values were refraction, uncorrected visual acuity, best corrected visual acuity, topographic data (Orbscan®, Bausch & Lomb, Rochester, NY, USA), and corneal wavefront analysis using Visual Optics Lab (VOL)-Pro 7.14 Software (Sarver and Associates). Vector analysis was performed using the Holladay, Cravy and Koch formula. Statistical analysis was performed to detect significances between visits using Student's t test.

RESULTS

All procedures were performed without any major complications. The mean follow-up was 13 months. The mean patient age was 48.7 years. The preoperative mean uncorrected visual acuity (logMAR) was 1.27, best corrected visual acuity 0.55, mean subjective cylinder -7.4 D, and mean topometric astigmatism 9.3 D. The postoperative mean uncorrected visual acuity (logMAR) was 1.12, best corrected visual acuity 0.47, mean subjective cylinder -4.1 D, and mean topometric astigmatism 6.5 D. Differences between corneal higher order aberrations showed a high standard deviation and were therefore not statistically significant.

CONCLUSIONS

Astigmatic keratotomy using the femtosecond laser seems to be a safe and effective tool for the correction of higher corneal astigmatisms. Due to the biomechanical properties of the cornea and missing empirical data for the novel femto-AK technology, higher numbers of patients are necessary to develop optimal treatment nomograms.

摘要

目的

本研究旨在通过回顾性病例系列,评估一种利用飞秒激光进行散光性角膜切开术(飞秒 - AK)来矫正穿透性角膜移植术后散光的新技术。

方法

分析了9例穿透性角膜移植术后存在高度残余散光的患者的10只眼睛的临床数据,这些患者使用60kHz飞秒激光(IntraLase™,AMO)进行了配对飞秒 - AK。一种新的软件算法用于在供体角膜植片上以不同的切割角度创建成对的弧形切口。观察指标包括验光、未矫正视力、最佳矫正视力、地形图数据(美国纽约罗切斯特市博士伦公司的Orbscan®)以及使用视觉光学实验室(VOL)-Pro 7.14软件(Sarver及合伙人公司)进行的角膜波前分析。使用霍拉迪、克拉维及科赫公式进行矢量分析。采用学生t检验进行统计分析以检测各次随访之间的差异。

结果

所有手术均未出现任何严重并发症。平均随访时间为13个月。患者平均年龄为48.7岁。术前平均未矫正视力(logMAR)为1.27,最佳矫正视力为0.55,平均主观柱镜度数为 -7.4 D,平均角膜地形图散光为9.3 D。术后平均未矫正视力(logMAR)为1.12,最佳矫正视力为0.47,平均主观柱镜度数为 -4.1 D,平均角膜地形图散光为6.5 D。角膜高阶像差之间的差异显示出较高的标准差,因此无统计学意义。

结论

使用飞秒激光进行散光性角膜切开术似乎是矫正较高角膜散光的一种安全有效的方法。由于角膜的生物力学特性以及缺乏关于新型飞秒 - AK技术的经验数据,需要更多患者来制定最佳治疗方案。

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