Mainguy A, Vabres B, Orignac I
Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
Service d'ophtalmologie, centre hospitalo-universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
J Fr Ophtalmol. 2022 Jun;45(6):640-646. doi: 10.1016/j.jfo.2021.09.010. Epub 2022 May 20.
To study the results of femtosecond laser-assisted arcuate keratotomy in extreme astigmatism after penetrating keratoplasty, using a Ziemer LDVZ6 with a modified Lindstrom nomogram.
Case series, retrospective study.
Consecutive eyes that underwent femtosecond laser-assisted arcuate keratotomy between 2014 and 2019 in the Nantes University Hospital for extreme astigmatism after penetrating keratoplasty were included.
Twenty-four eyes of 24 patients were included. The mean age was 53.3±12.2 years at the time of the arcuate keratotomies. Indications for penetrating keratoplasty were keratoconus in 66.7% of cases, herpes keratitis in 16.7% of cases, and corneal dystrophy in 16.7% of cases. The mean initial best corrected visual acuity was 0.36±0.23 logMar versus 0.26±0.15 logMar at the 3-month postoperative visit (P=0.04). At the postoperative visit, 54% (13/24) of eyes had improved best corrected visual acuity (BCVA), and 25% had no change in BCVA, with a mean cylinder reduction of 3.3 diopters. The mean preoperative topographic cylinder was 9.5±3.2 diopters versus 6.2±2.8 diopters postoperatively (absolute values; P<0.001), i.e. a 34.7% reduction in astigmatism. At the 3-month postoperative visit, 20.8% of eyes (5/24) had topographic astigmatism less than 3 diopters with a mean astigmatism reduction of 97±55% (range: 17; 201) using the Alpins method. No suppurative keratitis or endophthalmitis were observed. Twenty-one percent of patients underwent a second arcuate keratotomy after 3 to 6 months due to insufficient refractive results.
Development of new nomograms designed for extreme astigmatism after penetrating keratoplasty would enhance the precision and reproducibility of femtosecond laser-assisted arcuate keratotomy in these cases.
使用具有改良林德斯特罗姆列线图的Ziemer LDV Z6研究飞秒激光辅助弧形角膜切开术治疗穿透性角膜移植术后极端散光的效果。
病例系列，回顾性研究。
纳入2014年至2019年在南特大学医院接受飞秒激光辅助弧形角膜切开术治疗穿透性角膜移植术后极端散光的连续病例。
纳入24例患者的24只眼。弧形角膜切开术时的平均年龄为53.3±12.2岁。穿透性角膜移植术的指征为圆锥角膜占66.7%的病例，疱疹性角膜炎占16.7%的病例，角膜营养不良占16.7%的病例。平均初始最佳矫正视力为0.36±0.23 logMar，术后3个月随访时为0.26±0.15 logMar（P=0.04）。在术后随访时，54%（13/24）的眼最佳矫正视力（BCVA）有所改善，25%的眼BCVA无变化，平均柱镜降低3.3屈光度。术前平均地形图柱镜为9.5±3.2屈光度，术后为6.2±2.8屈光度（绝对值；P<0.001），即散光减少34.7%。在术后3个月随访时，20.8%的眼（5/24）地形图散光小于3屈光度，使用阿尔平斯方法平均散光减少97±55%（范围：17；201）。未观察到化脓性角膜炎或眼内炎。21%的患者在3至6个月后因屈光结果不足接受了第二次弧形角膜切开术。
为穿透性角膜移植术后极端散光设计新的列线图将提高这些病例中飞秒激光辅助弧形角膜切开术的精度和可重复性。
