飞秒激光辅助的大气泡法深板层角膜移植术治疗圆锥角膜后视觉质量

Visual quality after femtosecond laser-assisted deep anterior lamellar keratoplasty with big-bubble method for the treatment of keratoconus

目的观察飞秒激光辅助的大气泡法深板层角膜移植术(deep anterior lamellar keratoplasty,DALK)治疗圆锥角膜的视觉质量。方法使用自身对照观察法,纳入30例(50眼)圆锥角膜患者,均行飞秒激光下大气泡法DALK治疗,随访1 a观察疗效。结果30例(50眼)患者均顺利完成手术,术后早期术眼角膜植片均透明,角膜生理厚度恢复,植片与植床后弹力层贴合较好;术后7 d、1个月、6个月、1 a患眼裸眼视力、最佳矫正视力均高于术前(均为P<0.05),术后不同时间点间差异均无统计学意义(均为P>0.05)。术后不同时间点角膜曲率、角膜散光均较术前显著降低,角膜最薄点厚度较术前显著增加(均为P<0.05),术后7 d、1个月、6个月、1 a间各指标差异均无统计学意义(均为P>0.05)。术前内皮细胞密度为(2989.34±294.52)个·mm^(-2),术后1 a为(2821.19±325.51)个·mm^(-2),角膜内皮细胞丢失率为(5.62±0.56)%,术后7 d、1个月、6个月、1 a间差异不显著(均为P>0.05)。术中未见并发症发生;术后1眼伤口哆开,1眼缝线松弛,1眼发生基质层免疫排斥反应,未见其他并发症发生。结论圆锥角膜行飞秒激光辅助的大气泡法DALK治疗,疗效确切,安全性高,是中晚期患者较佳的术式选择。

Objective To observe the visual outcomes of big-bubble deep anterior lamellar keratoplasty （DALK） for the treatment of keratoconus using a femtosecond laser.Methods A total of 30 patients （50 affected eyes） with keratoconus were enrolled in the study by the self control observation method.All the patients were treated with femtosecond laser assisted DALK by large bubble method,and the curative effect was observed.Results All the 30 patients underwent the surgery successfully.In the early time after the surgery,the corneal grafts were transparent,the corneal physiological thickness was restored,and the grafts fitted the implant bed elastic layer well.The uncorrected visual acuity and the best corrected visual acuity on day 7,1 month,6 months and 1 year after surgery were higher than those before surgery （all P〈0.05）,but there was no significant difference between above time points （all P〉0.05）.The corneal curvature and corneal astigmatism were significantly decreased after surgery,the thickness of the thinnest cornea was significantly increased after surgery （all P〈0.05）,but there was no significant difference between the different time points after surgery （all P〉0.05）.The endothelial cell density before surgery and 1 year after surgery was （2989.34±294.52）·mm^-2 and （2821.19±325.51）·mm^-2,while loss rate of endothelial cell was （5.62±0.56）%,but there was no significant difference between different time points after surgery （all P〉0.05）.There were no complications during the surgery,but wound dehiscence occurred in 1 eye,loose suture in 1 eye,and stromal rejection in 1 eye,and there was no other complication after surgery.Conclusion It is safe and effective of femtosecond-laser assisted DALK by a big-bubble method to treat keratoconus,and it is a good choice for patients with advanced keratoconus.