Shimizu Tsutomu, Yamaguchi Takefumi, Satake Yoshiyuki, Shimazaki Jun
*Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and †Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan.
Cornea. 2015 Mar;34(3):257-63. doi: 10.1097/ICO.0000000000000333.
The aim of this study was to investigate topographic "hot spots" on the anterior corneal surface before Descemet stripping automated endothelial keratoplasty (DSAEK) and their effects on postoperative visual acuity and hyperopic shift.
Twenty-seven eyes of 27 patients with bullous keratopathy, who underwent DSAEK were studied. We defined a hot spot as a focal area with relatively high refractive power on the anterior corneal surface in eyes with bullous keratopathy. Refractive spherical equivalent, keratometric value, and corneal topography were retrospectively evaluated using anterior segment optical coherence tomography (AS-OCT).
Hot spots were identified in 11 eyes (42.3%) before DSAEK and disappeared in 9 eyes of these eyes (81.8%) at 6 months after DSAEK. AS-OCT revealed focal epithelial thickening in the same areas as the hot spots. There was no significant difference in the postoperative visual acuity between eyes with and without hot spots (P > 0.05). The keratometric value of the anterior corneal surface significantly flattened from 45.7 ± 2.7 diopters (D) before DSAEK to 44.2 ± 2.7 D 1 month after DSAEK in eyes with hot spots (P = 0.01), whereas in eyes without hot spots, there were no significant differences in the keratometric values before and after DSAEK. At 6 months, the refractive change was +1.1 ± 1.3 D in eyes with hot spots and -0.2 ± 0.6 D in eyes without hot spots (P = 0.034).
In eyes with focal epithelial thickening, topographic hot spots on the anterior corneal surface were observed using AS-OCT. The hot spots disappeared after DSAEK and had no influence on the postoperative visual acuity.
本研究旨在调查内皮剥除自动角膜内皮移植术（DSAEK）术前角膜前表面的地形学“热点”及其对术后视力和远视性移位的影响。
对27例行DSAEK的大泡性角膜病变患者的27只眼进行研究。我们将热点定义为大泡性角膜病变眼中角膜前表面屈光力相对较高的局部区域。使用眼前节光学相干断层扫描（AS-OCT）对屈光球镜等效度、角膜曲率值和角膜地形图进行回顾性评估。
11只眼（42.3%）在DSAEK术前发现有热点，其中9只眼（81.8%）在DSAEK术后6个月热点消失。AS-OCT显示热点区域存在局部上皮增厚。有热点和无热点的眼术后视力无显著差异（P>0.05）。有热点的眼在DSAEK术前角膜前表面角膜曲率值为45.7±2.7屈光度（D），术后1个月显著变平至44.2±2.7 D（P = 0.01），而无热点的眼在DSAEK术前和术后角膜曲率值无显著差异。6个月时，有热点的眼屈光变化为+1.1±1.3 D，无热点的眼为-0.2±0.6 D（P = 0.034）。
在存在局部上皮增厚的眼中，使用AS-OCT观察到角膜前表面的地形学热点。DSAEK术后热点消失，且对术后视力无影响。
