基质透镜植入角膜移植联合交联治疗重度圆锥角膜后的角膜表面变化
Corneal surface changes after stromal lenticule addition keratoplasty combined with cross-linking for severe keratoconus.
作者信息
Sun Xi-Yu, Shen Di, Chen Hao-Xi, Cao Wen-Jia, Zhou Kun, Wang Ya-Ni, Wang Rui, Wei Wei
机构信息
Xi'an No.1 Hospital; Shaanxi Institute of Ophthalmology; Shaanxi Key Laboratory of Ophthalmology; Clinical Research Center for Ophthalmology Diseases of Shaanxi Province, First Affiliated Hospital of Northwestern University, Xi'an 710002, Shaanxi Province, China.
出版信息
Int J Ophthalmol. 2025 Jun 18;18(6):1003-1010. doi: 10.18240/ijo.2025.06.05. eCollection 2025.
AIM
To investigate the response of the anterior and posterior corneal surface in femtosecond laser-assisted convex stromal lenticule addition keratoplasty (SLAK) combined with cross-linking (CXL) for treating keratoconus at the first 3mo of follow-up.
METHODS
In this prospective observational study, 20 eyes of 20 keratoconus patients who underwent SLAK combined with CXL were included. The morphological indices in keratometry and elevation data were recorded from the Sirius at baseline and 1 and 3mo postoperatively. The mean values of maximum keratometry (K), flat keratometry (K), and steep keratometry (K) at the central, 3-mm, 5-mm, and 7-mm areas were measured from the curvature map. The changes in anterior and posterior corneal elevation under the best-fit sphere (BFS) radius at seven points horizontally of the center, 3-mm, 5-mm, and 7-mm area from the center at both nasal (N) and temporal (T) side were measured from elevation map.
RESULTS
For the front corneal curvature, K, and K at 3-mm, 5-mm, and 7-mm of the anterior corneal surface increased significantly 1mo postoperatively (all <0.05) and remained unchanged until 3mo (>0.05). For the back corneal curvature, K and K along the 3-mm back meridian significantly decreased after month 1 (=0.002, 0.077, respectively). Posterior K-readings along the 5-mm and 7-mm did not change after surgery (>0.05). Anterior BFS decreased 1mo (<0.001) postoperatively but remained unchanged until 3mo after SLAK (>0.05). There was no change in posterior BFS before and after the surgery (>0.05). Anterior elevation at N5, N3, central, and T5 points and posterior elevation at central and T7 points shifted backward 1mo postoperatively (all <0.05) and remained stable until 3mo (>0.05).
CONCLUSION
The myopic SLAK combined with CXL is an economical alternative for stabilizing the corneal surface in severe keraoconus. "Pseudoprogression" occurs in the early phase postoperatively, but it is not an indicator of keratoconus progression.
目的
研究飞秒激光辅助基质透镜植入术（SLAK）联合交联术（CXL）治疗圆锥角膜术后随访3个月内角膜前后表面的反应。
方法
本前瞻性观察研究纳入20例接受SLAK联合CXL治疗的圆锥角膜患者的20只眼。在基线、术后1个月和3个月时，使用Sirius系统记录角膜曲率和高度数据的形态学指标。从曲率图中测量中央、3mm、5mm和7mm区域的最大角膜曲率（K）、平坦角膜曲率（K）和陡峭角膜曲率（K）的平均值。从高度图中测量中央、3mm、5mm和7mm区域中心水平方向七个点在鼻侧（N）和颞侧（T）的最佳拟合球面（BFS）半径下角膜前后表面高度的变化。
结果
对于角膜前表面曲率，术后1个月时前角膜表面3mm、5mm和7mm处的K和K显著增加（均<0.05），直至3个月时保持不变（>0.05）。对于角膜后表面曲率，术后1个月后，3mm后子午线方向的K和K显著降低（分别为=0.002，0.077）。5mm和7mm处的后K值术后未改变（>0.05）。术后1个月时前BFS降低（<0.001），但直至SLAK术后3个月保持不变（>0.05）。手术前后后BFS无变化（>0.05）。术后1个月时，鼻侧5点、鼻侧3点、中央和颞侧5点的前表面高度以及中央和颞侧7点的后表面高度向后移位（均<0.05），直至3个月时保持稳定（>0.05）。
结论
近视性SLAK联合CXL是稳定重度圆锥角膜角膜表面的一种经济有效的替代方法。术后早期会出现“假性进展”，但这不是圆锥角膜进展的指标。
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