A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Clinical Hospital of the Presidential Administration, Moscow, Russia.
Vestn Oftalmol. 2023;139(4):71-81. doi: 10.17116/oftalma202313904171.
The article presents the surgical technique of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) with femtosecond-laser assistance involving simultaneous implantation of an intracorneal continuous ring (ICCR) or an intracorneal ring segment (ICRS) into the graft. Surgical technique no. 1 - keratoplasty with simultaneous implantation of ICRS. Intrastromal circular tunnel is formed in the central zone of donor cornea using femtosecond laser. Then penetrating trepanation 8.1 mm in diameter is performed symmetrically to the formed tunnel. After preparing penetrating or lamellar recipient bed, suture fixation is placed in the corneal transplant, then the ICRS is implanted into the graft. Surgical technique no. 2 - keratoplasty with simultaneous implantation of ICCR. The donor cornea is dissected from periphery to center using femtosecond laser. Central zone remains untouched. A large diameter full-thickness trepanation is performed and the donor cornea is divided into the anterior and posterior layers. The ICCR is put on the donor cornea while holding the posterior layer with forceps. Penetrating or lamellar recipient bed is prepared, then the corneal graft is fixed with sutures. Transparent corneal graft acceptance does not guarantee high visual acuity due to post-keratoplasty astigmatism. Surgical correction of astigmatism is performed in the long term post-operatively and isn't effective enough. We proposed this new surgical technique of keratoplasty with simultaneous implantation of ICCR and ICRS into the graft as close as possible to the visual axis of the eye, which can help make the postoperative astigmatism minimal both immediately after surgery and in the long term. The study proposes a new approach to intraoperative prevention of post-keratoplasty astigmatism. The technique is simple, safe and effective. Analysis of long-term outcomes is required before recommending this method for widespread use in clinical practice.
本文介绍了在飞秒激光辅助下进行穿透性角膜移植术（PK）和深板层角膜移植术（DALK）的手术技术，包括同时将角膜内连续环（ICCR）或角膜内环段（ICRS）植入移植物中。手术技术 1 - 同时植入 ICRS 的角膜移植术。在供体角膜的中央区用飞秒激光形成间质环形隧道。然后对称于形成的隧道进行直径 8.1mm 的穿透环钻。准备好穿透或板层受区床后，在角膜移植中放置缝合固定，然后将 ICRS 植入移植物中。手术技术 2 - 同时植入 ICCR 的角膜移植术。使用飞秒激光从周边向中心对供体角膜进行解剖。中央区保持不动。进行大直径全厚度环钻，将供体角膜分为前层和后层。将 ICCR 放在供体角膜上，同时用镊子夹住后层。准备穿透或板层受区床，然后用缝线固定角膜移植片。透明角膜移植片的接受并不能保证高视力，因为术后存在散光。术后长期进行散光矫正，但效果并不理想。我们提出了这种新的角膜移植术，同时将 ICCR 和 ICRS 植入尽可能接近眼球的视轴，这有助于使术后散光在手术即刻和长期都最小化。该研究提出了一种新的术中预防术后散光的方法。该技术简单、安全、有效。需要对长期结果进行分析，然后才能推荐该方法在临床实践中广泛应用。
