Department of Ophthalmology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Cornea. 2013 Apr;32(4):390-5. doi: 10.1097/ICO.0b013e318254a4e4.
To review the long-term outcomes after femtosecond laser (FSL)-assisted mushroom configuration deep anterior lamellar keratoplasty (DALK).
Noncomparative case series of 19 eyes from 19 patients who underwent FSL-assisted mushroom configuration DALK.
Data were available for 14 eyes at 1 month, for 14 at 3 months, for 16 at 6 months, for 10 at 9 months, and for 8 at 1 year. Preoperative mean best-corrected visual acuity was 20/108 (range: 20/30-20/400). At 3 months, the mean best-corrected visual acuity was 20/46 (range: 20/25-20/250), and at a mean final follow-up of 13 months (range: 6-29) it was 20/35 (range: 20/15-20/200). The greatest change in mean spherical equivalent was at 3 months [-2.29 diopters (D), range: -7.38 to +3.38 D; from -9.54 D, range: -20.00 to +3.38 D, preoperatively]. There was 56% reduction in mean keratometric cylinder at 6 months (4.00 D, range: 1.04-8.75 D; from 9.13 D, range: 0.50-18.75 D, preoperatively). Complications included 3 cases (15.8%) of small Descemet membrane perforation, none of which required conversion to penetrating keratoplasty; 3 cases (15.8%) of stromal rejection that resolved with topical steroids; and 6 cases (31.6%) of steroid-related intraocular pressure rise that were treated with topical medications. Selective suture removal was initiated a mean of 3.5 months (range: 1.5-6 months) after surgery.
The use of the FSL to perform corneal cuts in a mushroom configuration for DALK is reliable and reproducible. Earlier visual rehabilitation may be possible because of the mechanical stability and wound healing advantages of stepped corneal wounds.
回顾飞秒激光（FSL）辅助蘑菇型深板层角膜移植（DALK）的长期效果。
对 19 名患者（19 只眼）进行 FSL 辅助蘑菇型 DALK 的非对照病例系列研究。
术后 1 个月、3 个月、6 个月、9 个月和 1 年分别有 14 只眼、14 只眼、16 只眼、10 只眼和 8 只眼可获取数据。术前最佳矫正视力平均为 20/108（范围：20/30-20/400）。术后 3 个月平均最佳矫正视力为 20/46（范围：20/25-20/250），平均最终随访时间为 13 个月（范围：6-29）时为 20/35（范围：20/15-20/200）。平均等效球镜的最大变化发生在术后 3 个月时[-2.29 屈光度（D），范围：-7.38 至+3.38 D；术前为-9.54 D，范围：-20.00 至+3.38 D]。术后 6 个月平均角膜散光减少 56%（4.00 D，范围：1.04-8.75 D；术前为 9.13 D，范围：0.50-18.75 D）。并发症包括 3 例（15.8%）微小的后弹力层撕裂，均无需改行穿透性角膜移植；3 例（15.8%）基质排斥反应，经局部皮质类固醇治疗后缓解；6 例（31.6%）皮质类固醇相关眼压升高，经局部药物治疗。术后平均 3.5 个月（范围：1.5-6 个月）开始选择性拆除缝线。
使用 FSL 进行蘑菇型角膜切开术进行 DALK 是可靠且可重复的。由于台阶状角膜伤口的机械稳定性和伤口愈合优势，可能更早地实现视力康复。
