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飞秒激光辅助下大直径板层角膜缘移植术治疗眼部化学伤

Femtosecond laser-assisted large-diameter lamellar corneal-limbal keratoplasty in ocular chemical burns.

作者信息

Lin Lixia, Xu Yuwei, Ou Zhancong, Zhuo Kaichen, Tian Dongyue, Chen Jiaqi, Gu Jianjun

机构信息

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China.

出版信息

Am J Ophthalmol Case Rep. 2024 Dec 27;37:102246. doi: 10.1016/j.ajoc.2024.102246. eCollection 2025 Mar.

DOI:10.1016/j.ajoc.2024.102246
PMID:39839915
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11745959/
Abstract

PURPOSE

This study highlights the feasibility of femtosecond laser-assisted large-diameter lamellar corneal-limbal keratoplasty and its efficacy in the treatment of ocular surface failure caused by bilateral ocular chemical injury.

OBSERVATIONS

The series included 3 patients with ocular surface failure caused by bilateral ocular chemical burns. After dissection of the host cornea, a femtosecond laser-assisted large-diameter lamellar corneoscleral button, with varying thickness of 250-400 μm, was sutured to the recipient bed. Postoperatively, patients were maintained on topical corticosteroids drops and systemic immunosuppression. Patients were followed up for a minimum of 16 months. The preoperative best corrected visual acuity was counting fingers, hand motions, and hand motions respectively. Postoperatively, the preoperative best corrected visual acuity reached 20/50, 20/50 and 20/40 at the last follow-up, respectively. A stable ocular surface was achieved in all but one eye, due to the cessation of immunosuppressive drugs. Postoperative anterior segment optical coherence tomography revealed well apposed graft interface in all cases.

CONCLUSIONS AND IMPORTANCE

Compared with conventional techniques, femtosecond laser is useful to create varying thickness corneoscleral graft to rehabilitate ocular surface and visual acuity in patients with bilateral ocular chemical burns.

摘要

目的

本研究强调了飞秒激光辅助大直径板层角膜缘移植术的可行性及其在治疗双眼化学伤所致眼表衰竭中的疗效。

观察结果

该系列包括3例因双眼化学烧伤导致眼表衰竭的患者。在对受体角膜进行剖切后，将厚度为250 - 400μm不等的飞秒激光辅助大直径板层角膜巩膜纽扣状物缝合至受体床。术后，患者持续使用局部皮质类固醇滴眼液并进行全身免疫抑制治疗。患者至少随访16个月。术前最佳矫正视力分别为指数、手动和手动。术后，最后一次随访时术前最佳矫正视力分别达到20/50、20/50和20/40。除一只眼外，其余所有眼均因停用免疫抑制药物而获得了稳定的眼表。术后眼前节光学相干断层扫描显示所有病例的移植界面贴合良好。

结论与意义

与传统技术相比，飞秒激光有助于制作不同厚度的角膜巩膜移植物，以恢复双眼化学烧伤患者的眼表和视力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/28e9dff4dbed/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/719d0f540455/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/dd8a313011a6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/5bdd8a84412f/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/cf673dced800/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/28e9dff4dbed/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/719d0f540455/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/dd8a313011a6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/5bdd8a84412f/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/cf673dced800/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8522/11745959/28e9dff4dbed/gr5.jpg

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本文引用的文献

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En Bloc Keratolimbal Allograft and Central Penetrating Keratoplasty: A Novel Surgical Technique in Severe Limbal Stem Cell Deficiency.整块角膜缘同种异体移植与中央穿透性角膜移植术：严重角膜缘干细胞缺乏症的一种新手术技术。
Cornea. 2023 May 1;42(5):656-661. doi: 10.1097/ICO.0000000000003199. Epub 2022 Dec 12.
2
Deep anterior lamellar limbo-keratoplasty for bilateral limbal stem cell deficiency with corneal scarring in chemical injury sequelae: Two case reports.深层前板层角膜缘移植术治疗化学伤后遗症双侧角膜缘干细胞缺乏伴角膜瘢痕：两例报告
Int J Surg Case Rep. 2022 Aug;97:107409. doi: 10.1016/j.ijscr.2022.107409. Epub 2022 Jul 14.
3
Epidemiology, economic and humanistic burdens of Ocular Surface Chemical Injury: A narrative review.
眼表化学性损伤的流行病学、经济学和人文负担：叙事性综述。
Ocul Surf. 2021 Apr;20:199-211. doi: 10.1016/j.jtos.2021.02.006. Epub 2021 Feb 27.
4
Allogeneic simple limbal epithelial transplantation: an appropriate treatment for bilateral stem cell deficiency.同种异体单纯性角膜缘上皮移植：治疗双侧干细胞缺乏症的一种合适方法。
BMJ Case Rep. 2021 Feb 5;14(2):e239998. doi: 10.1136/bcr-2020-239998.
5
Global Consensus on the Management of Limbal Stem Cell Deficiency.全球角膜缘干细胞缺乏症管理共识。
Cornea. 2020 Oct;39(10):1291-1302. doi: 10.1097/ICO.0000000000002358.
6
Keratolimbal allograft for limbal stem cell deficiency after severe corneal chemical injury: a systematic review.严重角膜化学伤后角膜缘干细胞缺乏的异体角结膜移植：系统评价。
Br J Ophthalmol. 2018 Aug;102(8):1114-1121. doi: 10.1136/bjophthalmol-2017-311249. Epub 2017 Nov 15.
7
Clinical results and influential factors of modified large-diameter lamellar keratoplasty in the treatment of total limbal stem cell deficiency.改良大直径板层角膜移植治疗完全性角膜缘干细胞缺乏的临床效果及影响因素。
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Ophthalmology. 2011 Feb;118(2):315-23. doi: 10.1016/j.ophtha.2010.06.037.
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