Department of Ophthalmology, RWTH Aachen University, Aachen, Germany.
Department of Electron Microscopy, University Hospital RWTH Aachen, Aachen, Germany.
Acta Ophthalmol. 2016 Dec;94(8):e731-e737. doi: 10.1111/aos.13118. Epub 2016 May 28.
We compared the SLc Original (SLc) and One-Use Plus (OUP) microkeratomes for ultrathin Descemet's stripping automated endothelial keratoplasty (DSAEK) lamella preparation and storage, vis-à-vis accuracy, endothelial cell loss (ECL) and lamellar surface roughness (LSR).
Twenty-five human corneas were dissected with single-use heads of different sizes aiming for a posterior lamella (PL) thickness of 85 μm, after which they were incubated for 6 days in a 5% dextran medium. Before preparation (0 hr) and 1, 24, and 144 hr after dissection, ECL and corneal thickness (CCT) were measured by ultrasound pachymetry (USP) and optical coherence tomography (OCT). Lamellar surface roughness (LSR) was assessed by scanning electron microscopy (SEM) and evaluated by two masked observers.
Prior to cutting, CCTs did not differ between OCT and USP measurements, with a high correlation between the two modalities (r = 0.8; p < 0.0001). Both systems succeeded in UT lamella preparation (CCT 40-130 μm) in 88% of cases. The OUP heads cut significantly deeper than the according SLc counterparts (p = 0.001), while the variance did not differ. The mean PL thickness increased significantly in the following incubation period (p = 0.01) with no difference between the keratome groups. Endothelial cell density (ECD) decreased significantly from before to 1 hr after preparation (-5.6%; p = 0.04), with no changes in the following 144-hr incubation period and no differences between the OUP and SLc group. Lamellar surface roughness (LSR) did not differ between both systems.
The SLc and the OUP system are both suited for the preparation of UT-DSAEK lamellae. Neither system differed significantly in variability, LSR or ECL, which did not increase during a 6-day incubation period.
我们比较了 SLc Original（SLc）和 One-Use Plus（OUP）两种微型角膜刀，以评估其在超薄 Descemet 膜撕除式自动化内皮角膜移植术（DSAEK）供体角膜瓣制备和储存方面的准确性、内皮细胞丢失（ECL）和角膜瓣表面粗糙度（LSR）。
25 个人眼角膜采用不同尺寸的一次性刀头进行解剖，目标是获得 85μm 的后弹力层（PL）厚度，然后在 5%葡聚糖培养基中孵育 6 天。在制备前（0 小时）以及解剖后 1、24 和 144 小时，使用超声角膜测厚仪（USP）和光学相干断层扫描（OCT）测量 ECL 和角膜厚度（CCT）。使用扫描电子显微镜（SEM）评估角膜瓣表面粗糙度（LSR），并由两名掩蔽观察者进行评估。
在切割之前，OCT 和 USP 测量的 CCT 没有差异，两种模式之间具有高度相关性（r=0.8；p<0.0001）。两种系统均成功制备了厚度为 40-130μm 的超薄角膜瓣（UT），成功率为 88%。OUP 刀头切割的深度明显大于相应的 SLc 刀头（p=0.001），但方差没有差异。在随后的孵育期内，PL 厚度显著增加（p=0.01），两种角膜刀组之间没有差异。内皮细胞密度（ECD）在制备后 1 小时内显著下降（-5.6%；p=0.04），在随后的 144 小时孵育期内没有变化，OUP 和 SLc 两组之间也没有差异。两种系统的角膜瓣表面粗糙度（LSR）没有差异。
SLc 和 OUP 系统都适用于制备超薄 DSAEK 角膜瓣。在变异性、LSR 或 ECL 方面，两种系统均无显著差异，并且在 6 天的孵育期间没有增加。
