Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239-4197, USA.
Cornea. 2011 Dec;30(12):1358-62. doi: 10.1097/ICO.0b013e318211410e.
To demonstrate feasibility and present postoperative outcomes for femtosecond laser-assisted keratoplasty (FLAK) in the setting of previous failed conventional penetrating keratoplasty (PK) and previous open-globe trauma with corneal laceration.
In this retrospective case series, data were collected for 12 consecutive patients at the Casey Eye Institute (Oregon Health and Science University, Portland, OR) with the primary diagnosis of either failed PK or open-globe trauma with corneal laceration that underwent zigzag incision FLAK. Outcome measures included topographic astigmatism, best spectacle-corrected visual acuity, uncorrected visual acuity, pinhole visual acuity, intraocular pressure, and timing of selective suture removal (or adjustment) over various follow-up intervals up to 18 months postoperatively.
Mean follow-up was 10.42 months. Mean postoperative topographic astigmatism ranged between 3.56 and 6.81 diopters (D). Mean best spectacle-corrected visual acuity (BSCVA) in logarithm of minimal angle of resolution (logMAR) equivalents ranged between 0.18 and 0.61 as compared with 1.28 for preoperative BSCVA (P = 0.0064). Thirty-three percent (4 of 12) of patients had significantly increased intraocular pressure develop during the first year of follow-up that required glaucoma therapy. No adverse events or complications occurred as a result of either the femtosecond laser procedure itself or during the transportation of the patient from the laser suite to the operating room.
FLAK is a feasible transplantation technique in the setting of previous failed PK and open-globe trauma with corneal laceration. Significant globe pressure associated with laser applanation did not cause rupture of old corneal wounds among our case series. Postoperative astigmatism is within previous reported limits in the literature under varying suturing techniques. Development of ocular hypertension within 1 year of follow-up was comparable with historically reported rates for PK in the setting of previous trauma and failed grafts.
展示在先前失败的传统穿透性角膜移植术（PK）和先前伴有角膜裂伤的开放性眼外伤的背景下，飞秒激光辅助角膜移植术（FLAK）的可行性，并介绍术后结果。
在这项回顾性病例系列研究中，俄勒冈健康与科学大学凯西眼科研究所（Casey Eye Institute，Oregon Health and Science University，Portland，OR）共收集了 12 例连续患者的数据，这些患者的主要诊断为先前失败的 PK 或伴有角膜裂伤的开放性眼外伤，他们均接受了 Z 字形切口 FLAK。主要观察指标包括角膜散光、最佳矫正视力、未矫正视力、小孔视力、眼压以及不同随访时间间隔（术后至 18 个月）选择性缝线拆除（或调整）的时间。
平均随访时间为 10.42 个月。术后平均角膜散光范围在 3.56 至 6.81 屈光度（D）之间。最佳矫正视力（BCVA）的最小分辨角对数（logMAR）等效值平均为 0.18 至 0.61，而术前 BCVA 为 1.28（P = 0.0064）。在术后 1 年的随访期间，有 33%（12 例中的 4 例）的患者眼压显著升高，需要进行青光眼治疗。没有任何不良事件或并发症是由飞秒激光手术本身或患者从激光套房转运至手术室的过程引起的。
在先前失败的 PK 和伴有角膜裂伤的开放性眼外伤的背景下，FLAK 是一种可行的移植技术。在我们的病例系列中，与激光压平相关的显著眼球压力并未导致旧角膜伤口破裂。在不同缝线技术下，术后散光处于文献中先前报道的范围内。在术后 1 年的随访期间，与先前创伤和失败移植物背景下的 PK 相比，发生眼内高压的比例相似。
