飞秒激光辅助微创板层角膜成形术（FL-MILK）治疗轻中度和进展性圆锥角膜的效果。
Effects of femtosecond laser-assisted minimally invasive lamellar keratoplasty (FL-MILK) on mild-to-moderate and advanced keratoconus.
机构信息
Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), Eye Institute of Shandong First Medical University, 372 Jingsi Road, Jinan, 250021, China.
State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Jinan, 250021, China.
出版信息
Graefes Arch Clin Exp Ophthalmol. 2023 Oct;261(10):2873-2882. doi: 10.1007/s00417-023-06093-2. Epub 2023 May 12.
PURPOSE
To compare the outcomes of femtosecond laser-assisted minimally invasive lamellar keratoplasty (FL-MILK) for mild-to-moderate keratoconus (KC) and advanced KC.
METHODS
Prospective case series study. Sixty-three eyes of 56 patients with progressive KC underwent FL-MILK were divided into group 1 [mean keratometry (Kmean) ≤ 53D] and group 2 (Kmean > 53D). Best spectacle-corrected visual acuity (BSCVA), Kmean, maximum keratometry (Kmax), anterior central corneal elevation (ACE), stiffness parameter A1 (SP-A1) and deformation amplitude (DA) were evaluated preoperatively and up to 24 months postoperatively.
RESULTS
Mean BSCVA improved from 0.34 ± 0.13 logMAR preoperatively to 0.25 ± 0.13 logMAR at 24 months postoperatively in group 1 (F = 10.10, P < .0001), and from 0.54 ± 0.31 logMAR to 0.40 ± 0.26 logMAR (F = 9.06, P = .0002) in group 2. Group 2 showed an average Kmax reduction of 10.9 D and an average Kmean reduction of 3.9 D at 24 months postoperatively (both P < .0001), whereas no significant change was observed in group 1. Average ACE decreased from 19.2 ± 10.0 to 5.2 ± 8.4 at 24 months postoperatively in group 1 (F = 28.5, P < .0001), and from 46.2 ± 16.3 to 19.1 ± 9.0 (F = 49.6, P < .0001) in group 2; SP-A1 increased from 53.8 ± 12.7 mmHg/mm to 95.9 ± 20.2 mmHg/mm in group 1 (F = 70.0, P < .0001), and from 38.6 ± 13.4 mmHg/mm to 89.3 ± 18.2 mmHg/mm (F = 96.9, P < .0001) in group 2; DA decreased from 1.30 ± 0.14 mm to 1.17 ± 0.13 mm in group 1 (F = 14.0, P < .0001), and from 1.40 ± 0.16 mm to 1.18 ± 0.10 mm (F = 27.6, P < .0001) in group 2.
CONCLUSIONS
FL-MILK can stabilize progressive KC in mild-to-moderate cases and advanced cases at 24-month follow-up. Steeper corneas are more likely to undergo flattening after FL-MILK.
CLINICAL TRIAL
Date of registration: July 16, 2017. The title of the trail: www.
CLINICALTRIALS
gov Trial registration number: NCT03229239. The name of the trial registry: ClinicalTrials.gov.
目的
比较飞秒激光辅助微创角膜层间切削术（FL-MILK）治疗轻中度和进展性圆锥角膜（KC）的疗效。
方法
前瞻性病例系列研究。63 只眼 56 例进展性 KC 患者接受了 FL-MILK 治疗，分为 1 组（平均角膜曲率（Kmean）≤53D）和 2 组（Kmean＞53D）。分别于术前和术后 24 个月评估最佳矫正视力（BCVA）、Kmean、最大角膜曲率（Kmax）、前中央角膜隆起（ACE）、硬度参数 A1（SP-A1）和变形幅度（DA）。
结果
1 组术后 24 个月平均 BCVA 从术前的 0.34±0.13 logMAR 提高到 0.25±0.13 logMAR（F=10.10，P＜0.0001），2 组从术前的 0.54±0.31 logMAR 提高到 0.40±0.26 logMAR（F=9.06，P=0.0002）。2 组术后 24 个月 Kmax 平均降低 10.9D，Kmean 平均降低 3.9D（均 P＜0.0001），而 1 组无明显变化。1 组术后 24 个月 ACE 从术前的 19.2±10.0 降低到 5.2±8.4（F=28.5，P＜0.0001），2 组从术前的 46.2±16.3 降低到 19.1±9.0（F=49.6，P＜0.0001）；SP-A1 在 1 组从术前的 53.8±12.7mmHg/mm 增加到 95.9±20.2mmHg/mm（F=70.0，P＜0.0001），2 组从术前的 38.6±13.4mmHg/mm 增加到 89.3±18.2mmHg/mm（F=96.9，P＜0.0001）；DA 在 1 组从术前的 1.30±0.14mm 降低到 1.17±0.13mm（F=14.0，P＜0.0001），2 组从术前的 1.40±0.16mm 降低到 1.18±0.10mm（F=27.6，P＜0.0001）。
结论
FL-MILK 可稳定轻中度和进展性 KC 患者在 24 个月随访时的角膜曲率，较陡的角膜更有可能在 FL-MILK 后变平。
临床试验
登记日期：2017 年 7 月 16 日。试验标题：www.clinicaltrials.gov。
临床试验注册
注册号：NCT03229239。试验注册机构：ClinicalTrials.gov。
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