Reinstein Dan Z, Gobbe Marine, Archer Timothy J, Youssefi Gerhard, Sutton Hugo F S
J Refract Surg. 2015 Jan;31(1):54-9. doi: 10.3928/1081597X-20141218-06.
To illustrate the concept of using a stromal surface topography-guided procedure for therapeutic repair after a complication following primary laser refractive surgery.
One case example of therapeutic retreatment for short nasal flap after primary LASIK performed in September 2000 is presented. The Artemis very high-frequency digital ultrasound arc-scanner (Arc-Scan, Inc., Morrison, CO) was used to obtain layered corneal thickness including epithelial thickness profile. Corneal front surface elevation was measured with the Orbscan II (Bausch & Lomb, Salt Lake City, UT). Stromal surface height was then calculated by subtracting epithelial thickness data from corneal front surface elevation data and used to calculate the ablation profile applied to the eye. The treatment was performed using the Ultralink system (ArcScan, Inc.), linking the ultrasound corneal thickness data with the Technolas 217c laser (Bausch & Lomb). Postoperative data were available at 30 days and 13 years.
One month after treatment, the epithelial thickness map demonstrated that the difference in thickness between the thinnest and thickest points located 2.5-mm nasally was reduced by 26 µm (from 56 to 30 µm). The axial difference map demonstrated an increase in corneal curvature of approximately 4 diopters where the cornea was the flattest nasally, thereby reducing the corneal asymmetry. The anterior elevation map also showed a reduced depression nasally. The patient reported significant improvement of her night vision.
This case example of stromal surface topography-guided treatment demonstrated a significant reduction in the irregularity of the stromal surface and an improvement in the topography, and the visual quality. Stromal surface topography-guided ablation might become the tool of the future for therapeutic repairs because it offers advantages over the current alternative of transepithelial phototherapeutic keratectomy.
阐述在原发性激光屈光手术后出现并发症时，使用基质表面地形引导程序进行治疗性修复的概念。
介绍一例2000年9月进行原发性准分子激光原位角膜磨镶术（LASIK）后短鼻瓣治疗性再治疗的病例。使用阿尔忒弥斯甚高频数字超声弧形扫描仪（Arc-Scan公司，科罗拉多州莫里森）获取包括上皮厚度轮廓在内的分层角膜厚度。用Orbscan II（博士伦公司，犹他州盐湖城）测量角膜前表面高度。然后通过从角膜前表面高度数据中减去上皮厚度数据来计算基质表面高度，并用于计算应用于眼睛的消融轮廓。使用Ultralink系统（ArcScan公司）进行治疗，将超声角膜厚度数据与Technolas 217c激光（博士伦公司）连接。术后30天和13年有数据可用。
治疗后1个月，上皮厚度图显示鼻侧2.5毫米处最薄点和最厚点之间的厚度差异减少了26微米（从56微米降至30微米）。轴向差异图显示在角膜最平坦的鼻侧区域角膜曲率增加了约4屈光度，从而减少了角膜不对称性。前表面高度图也显示鼻侧凹陷减少。患者报告其夜间视力有显著改善。
这个基质表面地形引导治疗的病例显示基质表面不规则性显著降低，地形和视觉质量得到改善。基质表面地形引导消融可能成为未来治疗性修复的工具，因为它比目前的经上皮光热角膜切削术更具优势。
