Liu Yu-Chi, Wittwer Valéry V, Yusoff Nur Zahirah M, Lwin Chan Nyein, Seah Xin Yi, Mehta Jodhbir S, Seiler Theo
Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.
Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore.
Cornea. 2019 May;38(5):648-653. doi: 10.1097/ICO.0000000000001851.
To describe the feasibility and outcomes of intraoperative optical coherence tomography (OCT)-guided, femtosecond laser-assisted deep anterior lamellar keratoplasty in which the lamellar and tunnel cuts were completed by laser.
The Ziemer Z8 system was used to scan the corneas intraoperatively and guide the stromal lamellar and tunnel cuts created by the laser. Thirty porcine eyes and 3 human cadaver globes were used to evaluate the accuracy of laser-created intrastromal tunnels and the feasibility of achieving big-bubble pneumatic dissection. The tunnel distance above the Descemet membrane (Dt-dm) was set at 100 and 130 μm, and the accuracy of laser cut was assessed by anterior segment OCT and histological sections. Fourteen patients with keratoconus or corneal scars were then included to evaluate the clinical outcomes.
The deviation from the targeted Dt-dm was 5.5% to 8.6% and 0.7% to 9.8% for the 100 and 130 μm groups, respectively. The achieved thickness had a significantly and positively strong correlation with the targeted thickness (r = 0.86; P < 0.001). In all cases, the anterior stromal lamella was removed without difficulty, except in the patients with corneal scars in whom some remaining stromal fiber attachments were observed. A type 1 big bubble was successfully achieved in all patients.
We present the accuracy and clinical outcomes of femtosecond laser-assisted, intraoperative OCT-guided deep anterior lamellar keratoplasty, in which controlled lamellar and tunnel cuts at desired depths were performed by laser in one step, and a successful big bubble was achieved.
描述术中光学相干断层扫描（OCT）引导下飞秒激光辅助深层前板层角膜移植术的可行性和结果，其中板层和隧道切口由激光完成。
使用Ziemer Z8系统在术中扫描角膜，并引导激光创建的基质板层和隧道切口。使用30只猪眼和3个供体人眼球评估激光创建的基质内隧道的准确性以及实现大泡气体分离的可行性。Descemet膜上方的隧道距离（Dt-dm）设定为100和130μm，并通过眼前节OCT和组织学切片评估激光切割的准确性。然后纳入14例圆锥角膜或角膜瘢痕患者以评估临床结果。
100μm组和130μm组与目标Dt-dm的偏差分别为5.5%至8.6%和0.7%至9.8%。实际获得的厚度与目标厚度呈显著正相关（r = 0.86；P < 0.001）。在所有病例中，除了角膜瘢痕患者观察到一些残留的基质纤维附着外，前基质板层均顺利去除。所有患者均成功实现1型大泡。
我们展示了飞秒激光辅助、术中OCT引导的深层前板层角膜移植术的准确性和临床结果，其中通过激光一步完成所需深度的可控板层和隧道切口，并成功实现大泡。
