Johnson & Johnson Surgical Vision, Milpitas, CA, USA.
Transl Vis Sci Technol. 2024 Nov 4;13(11):3. doi: 10.1167/tvst.13.11.3.
This study identified and compared variables causing changes in corneal tissue structure following the smooth incision lenticular keratomileusis (SILK) procedure using the ELITA Femtosecond Laser System by characterizing the resulting disrupted tissue interface.
Seventy-one ex vivo porcine eyes and six human cadaver eyes underwent ELITA SILK with diverse surgical steps, pulse energies, scan overlaps, and surgical methods. Flaps created with the iFS Advanced Femtosecond Laser and ELITA systems were also evaluated. The disrupted interface thickness was determined by imaging corneal layers at different depths through the interface with confocal microscopy and counting layers with elevated backscattered light via computer program-assisted, subject-matter-expert visual judgment with blinding.
The disrupted interface thickness for ELITA SILK was 25 ± 3 µm; for the ELITA flap, it was 25 ± 2 µm; and for the iFS flap, it was 32 ± 3 µm. Factors influencing the total ELITA SILK disrupted interface thickness included laser pulse energy (0.11 µm/nJ; P < 0.01), scan overlap (5 µm; P < 0.01), and mechanical manipulation (7 µm; P < 0.01). Varying surgical techniques for mechanical manipulation resulted in a difference in disrupted interface thickness of 4 µm (P < 0.01).
The ELITA SILK disrupted interface thickness was less than that of the iFS flap and similar to that of the ELITA flap. Assessing disrupted interface thickness identified factors influencing the quality of the corneal interface with SILK.
The disrupted interface thickness, a new method for measuring corneal damage, has been used to quantify the potential effects of various refractive surgery factors on surgical outcomes.
本研究通过对使用 ELITA 飞秒激光系统行平滑切口透镜角膜磨镶术（SILK）后角膜组织结构变化的变量进行识别和比较，来描述由此产生的组织界面破坏情况。
71 只离体猪眼和 6 只人尸眼接受了具有不同手术步骤、脉冲能量、扫描重叠和手术方法的 ELITA SILK 手术。还评估了使用 iFS 高级飞秒激光和 ELITA 系统制作的角膜瓣。使用共焦显微镜通过界面在不同深度成像角膜层，并通过计算机程序辅助、主题专家视觉判断（盲法）计算具有回散射光升高的层来确定破坏的界面厚度。
ELITA SILK 的破坏界面厚度为 25 ± 3 µm；ELITA 角膜瓣为 25 ± 2 µm；iFS 角膜瓣为 32 ± 3 µm。影响总 ELITA SILK 破坏界面厚度的因素包括激光脉冲能量（0.11 µm/nJ；P < 0.01）、扫描重叠（5 µm；P < 0.01）和机械操作（7 µm；P < 0.01）。不同的机械操作技术导致破坏界面厚度差异为 4 µm（P < 0.01）。
ELITA SILK 的破坏界面厚度小于 iFS 角膜瓣，与 ELITA 角膜瓣相似。评估破坏界面厚度确定了影响 SILK 角膜界面质量的因素。
钟佳惠
