Wang X, Qi X L, Wang M L, Su M, Li S X, Shi W Y, Gao H
Eye Institute of Shandong First Medical University, Eye Hospital of Shandong First Medical University (Shandong Eye Hospital), State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, School of Ophthalmology, Shandong First Medical University, Jinan 250021, China.
Zhonghua Yan Ke Za Zhi. 2023 Sep 11;59(9):723-729. doi: 10.3760/cma.j.cn112142-20230130-00034.
To evaluate the clinical application value of intraoperative optical coherence tomography (iOCT) in deep anterior lamellar keratoplasty (DALK) using the big-bubble technique to bare Descemet's membrane. Retrospective case series. Clinical data of 92 patients (92 eyes) with monocular stromal corneal diseases who underwent big-bubble DALK in the Eye Hospital of Shandong First Medical University from January 2020 to August 2021 were collected. There were 53 males and 39 females. The average age was (53.2±16.0) years old. All patients underwent iOCT scanning to determine the location and depth of the injection needle after initial removal of the corneal lesion, to observe the integrity of the recipient bed, Descemet's membrane, after complete lesion removal, and to observe the adhesion between the corneal graft and the recipient bed and check folds on the recipient bed after suturing of the corneal graft. The intraoperative perforation of Descemet's membrane, postoperative thickness of the cornea and the recipient bed, visual acuity, and corneal astigmatism were recorded. By iOCT, the thickness of the recipient bed was found to be about 1/2 of the corneal thickness and relatively uniform in all directions in 62 eyes (67.4%), so the sterile air was injected from the center of the recipient bed to separate it from the stromal layer. In 30 eyes (32.6%) with an uneven thickness of the recipient bed, the sterile air was injected from the paracentral area of the recipient bed. Under the guidance of iOCT scanning, 89 eyes (96.7%) did not experience any perforation of Descemet's membrane during surgery. The Descemet's membrane folds in the central 5-mm area of the recipient bed was observed and flattened in 20 eyes with the assistance of iOCT scanning. The postoperative corneal thickness was (578.95±108.26) μm, and the recipient bed thickness was (36.06±23.11) μm. The best corrected visual acuity of all patients at 6 months after surgery was 0.57±0.25 logMAR, which was significantly better than that before surgery (1.61±1.27 logMAR; 0.001). The average corneal astigmatism at 6 months after surgery was (2.72±2.44) diopters. The application of iOCT scanning in DALK surgery assisted by the big-bubble method can provide safe guidance for surgeons to adopt correct surgical procedures, decrease the risk of Descemet's membrane perforation, reduce the recipient bed folds, and facilitate corneal interlayer adhesion, thereby improving the visual prognosis.
评估术中光学相干断层扫描（iOCT）在使用大泡技术暴露后弹力层的深板层角膜移植术（DALK）中的临床应用价值。回顾性病例系列研究。收集了2020年1月至2021年8月在山东第一医科大学附属眼科医院接受大泡DALK手术的92例（92眼）单眼角膜基质疾病患者的临床资料。其中男性53例，女性39例。平均年龄为（53.2±16.0）岁。所有患者在初步切除角膜病变后均接受iOCT扫描，以确定注射针的位置和深度，在完全切除病变后观察植床、后弹力层的完整性，并在缝合角膜植片后观察角膜植片与植床之间的粘连情况以及检查植床上的褶皱。记录术中后弹力层穿孔情况、术后角膜和植床厚度、视力及角膜散光。通过iOCT发现，62眼（67.4%）植床厚度约为角膜厚度的1/2且各方向相对均匀，因此从植床中心注入无菌空气以将其与基质层分离。在30眼（32.6%）植床厚度不均匀的眼中，从植床旁中心区域注入无菌空气。在iOCT扫描引导下，89眼（96.7%）手术过程中未发生后弹力层穿孔。在iOCT扫描辅助下观察并展平了20眼中植床中央5mm区域的后弹力层褶皱。术后角膜厚度为（578.95±108.26）μm，植床厚度为（36.06±23.11）μm。所有患者术后6个月最佳矫正视力为0.57±0.25 logMAR，明显优于术前（1.61±1.27 logMAR；P<0.001）。术后x个月平均角膜散光为（2.72±2.44）D。大泡法辅助下iOCT扫描在DALK手术中的应用可为术者采用正确手术操作提供安全指导，降低后弹力层穿孔风险，减少植床褶皱，促进角膜层间粘连，从而改善视力预后。
