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激光原位角膜磨镶术后 5 年的角膜内皮细胞变化:飞秒激光与机械角膜刀。

Corneal endothelial cell changes 5 years after laser in situ keratomileusis: femtosecond laser versus mechanical microkeratome.

机构信息

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.

出版信息

J Cataract Refract Surg. 2012 Dec;38(12):2125-30. doi: 10.1016/j.jcrs.2012.07.034. Epub 2012 Oct 13.

Abstract

PURPOSE

To compare corneal endothelial cell density (ECD) and morphology between flap creation with a femtosecond laser and flap creation with a mechanical microkeratome 5 years after laser in situ keratomileusis (LASIK).

SETTING

Mayo Clinic, Rochester, Minnesota, USA.

DESIGN

Prospective randomized masked paired-eye study.

METHODS

In this study of LASIK for myopia or myopic astigmatism, fellow eyes were randomized by ocular dominance to flap creation by a femtosecond laser or by a mechanical microkeratome. Central endothelial images were analyzed before and 3 years and 5 years after LASIK; endothelial cell variables were compared between treatments at each examination. Relationships between endothelial cell loss and contact lens wear, residual bed thickness, and preoperative refractive error were evaluated.

RESULTS

There were no differences in the ECD, percentage of hexagonal cells, or coefficient of variation of cell area between treatments at any examination (all P = .99); the smallest detectable differences were 120 cells/mm(2), 5%, and 2%, respectively. The mean annual rate of corneal endothelial cell loss was -0.1% ± 1.2% (SD) and -0.1% ± 1.0% for the femtosecond laser and the mechanical microkeratome, respectively. Endothelial cell loss was not associated with contact lens wear, residual bed thickness, or preoperative refractive error.

CONCLUSIONS

The energy delivered to the cornea during femtosecond laser flap creation did not affect the corneal endothelium 5 years after LASIK when compared with flap creation with a mechanical microkeratome. Corneas that have had either method of flap creation could be accepted as donor tissue for endothelial keratoplasty from the standpoint of endothelial health.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

摘要

目的

比较飞秒激光制瓣与机械角膜刀制瓣的 LASIK 术后 5 年角膜内皮细胞密度(ECD)和形态的差异。

设置

美国明尼苏达州罗切斯特市梅奥诊所。

设计

前瞻性随机对照配对眼研究。

方法

这项 LASIK 治疗近视或近视散光的研究中,根据主导眼随机将双眼分为飞秒激光制瓣组和机械角膜刀制瓣组。在 LASIK 术前、术后 3 年和 5 年分别分析中央角膜内皮图像;在每次检查时比较两种治疗方法之间的内皮细胞变量。评估内皮细胞丢失与隐形眼镜佩戴、剩余床厚度和术前屈光不正的关系。

结果

在任何检查时,两种治疗方法的 ECD、六边形细胞百分比或细胞面积变异系数均无差异(均 P =.99);最小可检测差异分别为 120 个细胞/mm(2)、5%和 2%。角膜内皮细胞每年平均丢失率分别为飞秒激光和机械角膜刀组 -0.1%±1.2%(标准差)和-0.1%±1.0%。内皮细胞丢失与隐形眼镜佩戴、剩余床厚度或术前屈光不正无关。

结论

与机械角膜刀制瓣相比,飞秒激光制瓣时施加于角膜的能量不会影响 LASIK 术后 5 年的角膜内皮。从内皮健康的角度来看,接受过这两种制瓣方法的角膜都可以作为内皮角膜移植的供体组织。

金融披露

没有作者在任何材料或方法上有财务或所有权利益。

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