飞秒激光辅助深层前板层角膜移植术：圆锥角膜手术中的更安全选择。
Femtosecond laser-assisted deep anterior lamellar keratoplasty: A safer option in keratoconus surgery.
机构信息
Department of Ophthalmology, 159158Dell'Angelo Hospital, Venice, Italy.
9317Ophthalmology Complex Operative Unit, 9317University Campus Bio-Medico, Italy.
出版信息
Eur J Ophthalmol. 2022 Jan;32(1):59-65. doi: 10.1177/11206721211059023. Epub 2021 Nov 13.
PURPOSE
To evaluate postoperative safety of femtosecond laser deep anterior lamellar keratoplasty performed with an innovative anvil profile in keratoconus patients.
METHODS
This is a single-center, retrospective cohort study. We reviewed medical records of 89 keratoconus patients that underwent femtosecond laser deep anterior lamellar keratoplasty surgery (46 eyes) and manual deep anterior lamellar keratoplasty (47 eyes). Inclusion criteria required: age > 18 years old, best-corrected visual acuity < 0.3 LogMAR, continuous suture of the graft, postoperative immunomodulant regimen with dexamethasone 0.1% for 6 months and at least 12 months follow-up. Previous eye surgery, hydrops, and other ocular disease were excluded. The main outcome measures were postoperative events: rejections, persistent epithelial defects, and graft failures.
RESULTS
During the follow-up (20 ± 6 months) graft rejection was diagnosed in 0 of femtosecond laser deep anterior lamellar keratoplasty versus 6 (17%) of manual deep anterior lamellar keratoplasty [ 0.027], persistent epithelial defect in 0 of femtosecond laser deep anterior lamellar keratoplasty versus in 4 (11%) of manual deep anterior lamellar keratoplasty [ 0.048] and graft failure occurred in 4 (11%) of manual deep anterior lamellar keratoplasty. The best-corrected visual acuity, after removal of sutures, was better in the femtosecond laser deep anterior lamellar keratoplasty group 0.09 ± 0.08 LogMAR versus 0.16 ± 0.13 LogMAR in manual deep anterior lamellar keratoplasty [ 0.035] group although refractive spherical equivalent and cylinder, topographic average keratometry and cylinder were similar.
CONCLUSIONS
Anvil-shaped femtosecond laser deep anterior lamellar keratoplasty in keratoconus surgery increases safety and readiness of recovery, decreasing the incidence of corneal rejection, epithelial defects, graft failures, and producing better best-corrected visual acuity after removal of sutures.
目的
评估在圆锥角膜患者中使用创新的砧型进行飞秒激光深板层角膜切开术的术后安全性。
方法
这是一项单中心回顾性队列研究。我们回顾了 89 例圆锥角膜患者的病历，这些患者均接受了飞秒激光深板层角膜切开术（46 只眼）和手动深板层角膜切开术（47 只眼）。纳入标准为：年龄>18 岁，最佳矫正视力<0.3 LogMAR，移植物连续缝合，术后免疫调节剂方案为 0.1%地塞米松治疗 6 个月，随访至少 12 个月。排除既往眼部手术、水肿和其他眼部疾病。主要观察指标为术后事件：排斥反应、持续性上皮缺损和移植物失败。
结果
在随访期间（20±6 个月），飞秒激光深板层角膜切开术组有 0 例（0%）诊断为移植物排斥反应，而手动深板层角膜切开术组有 6 例（17%）[0.027]；飞秒激光深板层角膜切开术组有 0 例（0%）持续性上皮缺损，而手动深板层角膜切开术组有 4 例（11%）[0.048]；手动深板层角膜切开术组有 4 例（11%）发生移植物失败。在去除缝线后，飞秒激光深板层角膜切开术组的最佳矫正视力更好，为 0.09±0.08 LogMAR，而手动深板层角膜切开术组为 0.16±0.13 LogMAR[0.035]，但屈光球镜和柱镜、角膜地形平均角膜曲率和柱镜相似。
结论
在圆锥角膜手术中使用砧型飞秒激光深板层角膜切开术可提高安全性和恢复准备性，降低角膜排斥反应、上皮缺损、移植物失败的发生率，并在去除缝线后获得更好的最佳矫正视力。
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