飞秒激光辅助的两种深板层角膜移植治疗圆锥角膜疗效比较

Comparison of two surgical techniques of femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus

目的比较飞秒激光辅助的切除75%以上基质层的深板层角膜移植(deep anterior lamellar keratoplasty,DALK)(preDescemetic DALK)和飞秒激光联合Anwar大气泡技术切除全部基质层DALK(Descemetic DALK)治疗圆锥角膜的临床效果。方法17例20眼圆锥角膜患者,9例10眼行飞秒激光辅助的pre-Descemetic DALK,8例10眼行飞秒激光辅助的Anwar大气泡Descemetic DALK,术后随访1 a,比较2组术后最佳矫正视力(best-corrected visual acuity,BCVA)、屈光状态、角膜曲率、内皮细胞丢失率及中央角膜厚度。结果所有手术顺利完成。术后1 a,pre-Descemetic DALK组BCVA为0.52±0.24,Descemetic DALK组BCVA为0.49±0.19,差异无统计学意义(P=0.758);pre-Descemetic DALK组近视度数为(-9.43±7.44)D,地形图测量角膜散光度数为(3.73±2.58)D,Descemetic DALK组近视度数为(-1.03±1.13)D,角膜散光度数为(3.21±3.10)D,两组间近视度差异显著(P=0.002),散光度数差异无统计学意义(P=0.684);角膜曲率pre-Descemetic DALK组为(44.30±4.18)D,Descemetic DALK组为(42.21±2.82)D,差异无统计学意义(P=0.208),内皮细胞丢失率分别为4.6%和6.4%,差异无统计学意义(P=0.258)。术后中央角膜厚度pre-Descemetic DALK组为(483.40±53.70)μm,Descemetic DALK组为(471.50±41.68)μm,差异无统计学意义(P=0.587)。结论飞秒激光辅助的大气泡Descemetic DALK术后屈光状态显示近视度数小,可作为治疗中晚期圆锥角膜的更好术式。

Objective To compare the outcomes of femtosecond laser-assisted deep anterior lamellar keratoplasty（DALK） ,in which more than 75% of the stroma is removed （pre-Descemetic DALK） and the femtosecond laser-assisted DALK performed with the big bubble technique, in which all of the stroma is removed, leaving only the Descemet membrane and endothelium （ Descemetic DALK） in cases of keratoconus. Methods Retrospective comparative case series. Twenty eyes of 17 patients were diagnosed as keratoconus. Femtosecond laser-assisted pre-Descemetic DALK was performed in 10 eyes of 9 patients and Femtosecond laser-assisted Descemetic DALK using Anwar big bubble technique in 10 eyes of 8 patients. Mean follow-up was one year. The postoperative best-corrected visual acuity （ BCVA）, refractive status, keratometry, endothelial cell loss, and central corneal thickness between the two surgical techniques were compared. Results All surgeries were completed successfully. At one year postoperative examination, BCVA was 0.52 ±0.24 in pre-Descemetic DALK group and 0.49 ±0. 19 in Descemetic DALK group（P =0.758）. The myopia were （ - 9.43 ± 7.44） D and （ - 1.03 ± 1. 13） D in the pre-Descemetic DALK and Descemetic DALK groups, respectively （ P = 0. 002）. Topographic astigmatism were （3.73 ±2.58） D and （3.21 ± 3.10） D in the pre- Descemetic DALK and Descemetic DALK groups, respectively （P = 0.684）. The keratometry were （44.30 ±4.18）D and （42.21 ±2.82）D in the pre-Descemetic DALK and Descemetic DALK groups, respectively （P = 0. 208 ）. The endothelial cell loss were 4.6% and 6.4% in the pre-Descemetic DALK and Descemetic DALK groups ,respectively （P = 0.258）. The central corneal thickness were （483.40 ± 53.70） μm and （ 471.5 ± 41.68 ） μm in the pre-Descemetic DALK and Descemetic DALK groups, respectively （P = 0. 587）. Conclusion The patients who underwent the Descemetic femtosecond laserassisted DALK technique show postoperative low myopia, and can be considered as the better surgical technique for moderate and advanced keratoconus.