角膜组织补充性角膜移植术：一种使用飞秒激光塑形的保存角膜组织治疗圆锥角膜的新型基质内植入手术。
Corneal tissue addition keratoplasty: new intrastromal inlay procedure for keratoconus using femtosecond laser-shaped preserved corneal tissue.
作者信息
Greenstein Steven A, Yu Austin S, Gelles John D, Eshraghi Hamoon, Hersh Peter S
机构信息
From the Cornea and Laser Eye Institute, CLEI Center for Keratoconus, Teaneck, New Jersey (Greenstein, Yu, Gelles, Hersh); Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, New Jersey (Greenstein, Gelles, Eshraghi, Hersh).
出版信息
J Cataract Refract Surg. 2023 Jul 1;49(7):740-746. doi: 10.1097/j.jcrs.0000000000001187.
PURPOSE
To report results of Corneal Tissue Addition Keratoplasty (CTAK) for keratoconus (KC) and ectasia after laser in situ keratomileusis.
SETTING
Cornea and refractive surgery practice.
DESIGN
Single center, prospective, open label clinical trial.
METHODS
21 eyes of 18 patients underwent CTAK. A tissue inlay of preserved corneal tissue was cut to customized specifications with a femtosecond laser and placed in a laser-created channel in the host cornea. Postoperative uncorrected and corrected distance visual acuity (UDVA, CDVA), manifest refraction spherical equivalent (MRSE), topographic mean keratometry (Kmean), maximum keratometry (Kmax), and the point of maximum flattening (Kmaxflat) were measured.
RESULTS
Average UDVA improved from 1.21 ± 0.35 logMAR lines (LL) (20/327) to 0.61 ± 0.25 LL (20/82) ( P < .001). Average CDVA improved from 0.62 ± 0.33 LL (20/82) to 0.34 ± 0.21 LL (20/43) ( P = .002), and average MRSE improved from -6.25 ± 5.45 diopters (D) to -1.61 ± 3.33 D ( P = .002). Individually, 20 eyes (95.2%) gained more than 2 lines of UDVA, with 10 eyes (47.6%) gaining more than 6 lines, and no eyes worsening. 12 eyes (57.1%) gained at least 2 lines of CDVA, with 1 eye worsening by more than 2 lines. At 6 months, average Kmean flattened by -8.44 D ( P = .002), Kmax flattened by -6.91 D ( P = .096), and mean Kmaxflat was -16.03 D.
CONCLUSIONS
CTAK is a promising procedure to improve visual acuity and topography in patients with KC and ectasia.
目的
报告角膜组织附加性角膜移植术（CTAK）治疗圆锥角膜（KC）及准分子原位角膜磨镶术后角膜扩张的效果。
机构
角膜与屈光手术诊所。
设计
单中心、前瞻性、开放标签临床试验。
方法
18例患者的21只眼接受了CTAK手术。用飞秒激光将保存的角膜组织镶嵌片切割成定制规格，然后置于受体角膜的激光制作通道内。测量术后裸眼及矫正远视力（UDVA、CDVA）、明显验光球镜等效度（MRSE）、地形图平均角膜曲率（Kmean）、最大角膜曲率（Kmax）以及最大平坦点（Kmaxflat）。
结果
平均UDVA从1.21±0.35最小分辨角对数（logMAR）行（LL）（20/327）提高到0.61±0.25 LL（20/82）（P<.001）。平均CDVA从0.62±0.33 LL（20/82）提高到0.34±0.21 LL（20/43）（P =.002），平均MRSE从-6.25±5.45屈光度（D）提高到-1.61±3.33 D（P =.002）。单眼来看，20只眼（95.2%）的UDVA提高超过2行，10只眼（47.6%）提高超过6行，无眼视力恶化。12只眼（57.1%）的CDVA至少提高2行，1只眼视力恶化超过2行。在6个月时，平均Kmean变平-8.44 D（P =.002），Kmax变平-6.91 D（P =.096），平均Kmaxflat为-16.03 D。
结论
CTAK是一种有望改善KC和角膜扩张患者视力及地形图的手术方法。
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