Department of Corneal and External Eye Diseases, Moorfields Eye Hospital, London, United Kingdom.
Department of Corneal and External Eye Diseases, Moorfields Eye Hospital, London, United Kingdom.
Am J Ophthalmol. 2020 Dec;220:191-202. doi: 10.1016/j.ajo.2020.07.023. Epub 2020 Jul 21.
To compare the clinical outcomes in femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public healthcare setting.
Single-center, comparative, retrospective interventional case series.
Population: Consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015, to September 1, 2018 and big-bubble M-DALK from September 1, 2012, to September 30, 2016.
Moorfields Eye Hospital, London.
Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions, and visual outcomes were archived on a customized spreadsheet for analysis. MainOutcomeMeasures: Rate of intraoperative perforation and conversion to penetrating keratoplasty (PK) and the percentage of patients, post removal of sutures (ROS), with corrected distance visual acuity (CDVA) ≥20/40.
We analyzed 58 eyes of 55 patients who underwent F-DALK and 326 eyes of 309 patients who underwent M-DALK. Intraoperative perforation of Descemet membrane occurred in 15 of 58 (25.9%) F-DALK cases compared to 148 of 326 (45.4%) M-DALK cases (P = .006). Intraoperative conversion to PK was carried out in 2 of 58 (3.4%) F-DALK cases compared to 80 of 326 (24.5%) M-DALK cases (P = .001). Post ROS, 86.5% of F-DALK eyes had a CDVA of ≥20/40 (15 ± 7.3 months after surgery) compared to 83.7% of M-DALK eyes (24.9 ± 10.6 months) (P = .825).
Laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet perforation and the conversion to PK in a multi-surgeon setting.
在多医生公共医疗环境中，比较飞秒激光辅助深层前弹力层角膜切开术（F-DALK）与手动非激光深层前弹力层角膜切开术（M-DALK）治疗圆锥角膜的临床效果。
单中心、对比、回顾性干预性病例系列。
人群：2015 年 8 月 1 日至 2018 年 9 月 1 日期间，连续接受飞秒激光大泡 F-DALK 治疗的圆锥角膜患者，以及 2012 年 9 月 1 日至 2016 年 9 月 30 日期间接受飞秒激光大泡 M-DALK 治疗的圆锥角膜患者。
伦敦摩尔菲尔德眼科医院。
术前状态、手术细节、术中及术后并发症、二次干预和视力结果等数据均存档在一个定制的电子表格中进行分析。
术中穿孔率和穿透性角膜移植术（PK）的转化率，以及去除缝线后（ROS）有多少患者的矫正视力（CDVA）≥20/40。
共分析了 58 只眼（55 例患者）接受 F-DALK 治疗和 326 只眼（309 例患者）接受 M-DALK 治疗的患者数据。F-DALK 术中发生 15 例（25.9%）Descemet 膜穿孔，而 M-DALK 术中发生 148 例（45.4%）（P=0.006）。F-DALK 术中改行 PK 术 2 例（3.4%），M-DALK 术中改行 PK 术 80 例（24.5%）（P=0.001）。ROS 后，86.5%的 F-DALK 眼视力≥20/40（术后 15 ± 7.3 个月），而 83.7%的 M-DALK 眼视力≥20/40（术后 24.9 ± 10.6 个月）（P=0.825）。
在多医生环境中，自动化激光处理 DALK 的某些步骤可能会降低术中 Descemet 膜穿孔的发生率和改行 PK 的发生率。
