Department of Ophthalmology, University Hospital Kralovske Vinohrady and Third Faculty of Medicine Charles University, Prague, Czech Republic.
Eye Clinic Horni Pocernice, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2024 Mar;168(1):55-61. doi: 10.5507/bp.2023.004. Epub 2023 Jan 25.
PURPOSE: To evaluate the safety and efficacy of using corneal stromal lenticules (CSLs) obtained during refractive surgery Refractive Lenticule Extraction (ReLEx) with the Small Incision Lenticule Extraction (SMILE) procedure for the treatment of corneal ulcers. METHODS: This retrospective study included 12 eyes of 12 patients, 7 men and 5 women with varying degrees of corneal ulcer. The mean age was 64 ± 18 (range 34 to 95 years). The monitoring included corrected distance visual acuity (CDVA), slit-lamp biomicroscopy examination, a Seidel test, stability of the graft and anterior segment optical coherence tomography (AS-OCT) inspection. Patients were closely monitored for possible postoperative complications for at least 6 months. RESULTS: In 7/12 (58%) eyes, the corneal ulcer was successfully sealed with CSL and amniotic membrane (AM) without the need for any additional surgical intervention. In 3 eyes, penetrating keratoplasty (PK) was needed in addition to CSL transplantation and in 2 eyes the scleral patch was used to fully seal after CSL transplantation. During the follow-up period no signs of rejection or infection were detected in any patient. CONCLUSION: The use of CSLs from ReLEx SMILE may be considered as an alternative method for the treatment of corneal ulcers before a more extensive and definitive solution - PK - is used. Our preliminary findings suggest that properly performed CSL transplantation using cryopreserved lenticules is a safe and effective method to temporarily cover the corneal partial-thickness defect or even perforation.
目的:评估在 Refractive Lenticule Extraction(ReLEx)屈光性透镜切除术过程中获得的角膜基质透镜(CSL)与小切口透镜切除术(SMILE)联合应用于治疗角膜溃疡的安全性和有效性。
方法:本回顾性研究纳入了 12 例 12 只眼的患者,7 名男性和 5 名女性,其角膜溃疡程度不一。平均年龄为 64±18 岁(范围 34 至 95 岁)。监测包括矫正远视力(CDVA)、裂隙灯生物显微镜检查、Seidel 试验、移植物稳定性和眼前节光学相干断层扫描(AS-OCT)检查。密切监测患者至少 6 个月的可能术后并发症。
结果:在 12 只眼中的 7 只(58%)眼中,CSL 和羊膜(AM)成功地封闭了角膜溃疡,无需任何进一步的手术干预。在 3 只眼中,除了 CSL 移植外,还需要穿透性角膜移植(PK),在 2 只眼中,CSL 移植后使用巩膜贴片完全封闭。在随访期间,没有发现任何患者有排斥或感染的迹象。
结论:在考虑更广泛和更确定的解决方案-PK 之前,ReLEx SMILE 产生的 CSL 可被视为治疗角膜溃疡的替代方法。我们的初步研究结果表明,正确进行冷冻保存的 CSL 移植是一种安全有效的方法,可暂时覆盖角膜部分厚度缺损甚至穿孔。
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