Femtosecond laser-assisted deep anterior lamellar keratoplasty in phototherapeutic keratectomy versus the big-bubble technique in keratoconus

AIM：To compare the functional and anatomic results of femtosecond laser（FSL）-assisted deep anterior lamellar keratoplasty（DALK） associated with phototherapeutic keratectomy（PTK） and FSL-assisted DALK performed using the big-bubble technique in keratoconus.METHODS：During the first phase of the study,an electron microscopy histopathology pilot study was conducted that included four unsuitable donor corneas divided into two groups：in FSL group,FSL lamellar cuts were performed on two corneas and in FSL＋PTK group,PTK was performed at the stromal beds of two corneas after FSL lamellar cuts were made.During the second phase of the study,a randomized clinical trial was conducted that included two treatment groups of patients with keratoconus：group 1（n=14 eyes） underwent FSL-assisted DALK associated with PTK and group 2（n=12 eyes） underwent FSL-assisted DALK associated with the bigbubble technique.The main outcome measures were the postoperative visual acuity（VA） and optical coherence tomography（OCT） measurements,confocal microscopic findings,and contrast sensitivity.RESULTS：In the pilot study,histopathology showed a more regular stromal bed in the FSL＋PTK group.In the clinical trial,group 1 had significantly worse best spectaclecorrected VA and contrast sensitivity（P〈0.05 for both comparisons）.The residual stromal bed measured by OCT was significantly（P〈0.05） thicker in group 1.Confocal microscopy detected opacities only at the donor-receptor interface in group 1.CONCLUSION：Patients with keratoconus treated with FSL-assisted DALK performed using the big-bubble technique fare better than treated with FSL-assisted DALK associated with PTK.

Fourier-domain optical coherence tomography-guided phototherapeutic keratectomy for the treatment of anterior corneal scarring

AIM:To evaluate the safety,visual and anatomic outcomes of fourier-domain optical coherence tomography(FD-OCT)-guided excimer laser phototherapeutic keratectomy(PTK)combined with photorefractive keratectomy(PRK)surgery in treating anterior corneal scarring.METHODS:Clinical data of 23 eyes of 21 patients with anterior corneal scarring underwent FD-OCT-guided PTK and PRK from Dec.2014 to Jul.2016 were reviewed.Patients were assessed for preoperative and postoperative uncorrected visual acuity(UCVA),best spectacle-corrected visual acuity(BSCVA),contrast sensitivity(CS),FD-OCT,corneal topography and colour figures of anterior segments.RESULTS:The preoperative corneal pathologic conditions included viral keratitis(7 patients,7 eyes),band keratopathy(2 patients,4 eyes),corneal dystrophy(4 patients,4 eyes),traumatic corneal disease(2 patients,2 eyes)and corneal chemical injury(6 patients,6 eyes).Mean follow-up time was 10.65(range,3-19)mo.UCVA(in IogMAR)improved from a mean of 0.79(95%Cl,0.28­1.29)preoperatively to a mean of 0.45(95%Cl,0.29-0.62)postoperatively(P=0.021).BSCVA(in IogMAR)improved from 0.57(95%Cl,0.27-0.88)preoperatively to a mean of 0.28(95%Cl,0.15-0.41)postoperatively(P=0.001).Corneal topographic indices postoperatively showed significant improvement in corneal cylinder(P=0.009),the surface regularity index(P=0.007)and surface asymmetry index(P=0.00).Postoperative spherical equivalent averaged-0.53 diopters(-1.49 to 0.42).No complications were associated with the treatment.CONCLUSION:FD-OCT-guided PTK combined with PRK is safe and effective for the treatment of anterior corneal scarring by eliminating or reducing corneal opacities.

Phototherapeutic Keratectomy Combined with Photorefractive Keratecto-my for Treatment of Myopia with Corneal Scars

To evaluate the effect of phototherapeutic keratectomy combined with photorefractive ker- atectomy in the treatment of myopia with corneal scars, corneal epithelium was removed with laser plus scraping. Corneal scars were removed with PTK, followed by PRK for myopia. Healon was used to make corneal surface smoother during operation. 30 eyes of 24 cases of myopia with corneal scars were followed up for one year. Mean corrected vision was 0. 51 and myopic degree was -6. 42D ±4. 26D before operation. After operation, corneal scars of 21 eyes (70. 0%) were removed in oper- ative zone. The vision of 27 operated eyes (90. 0%) was equal to or better than best corrected vi- sion. Mean postoperative visual acuity was 0. 72. Corneal surface was smoother and astigmatism was reduced after the surgery. Our study showed that PTK combined with PRK is a safe and effective treatment for myopia with corneal scars.

眼前节OCT辅助PTK治疗颗粒状角膜营养不良

目的：探讨眼前节光学相干断层扫描仪（optical coherence tomography，OCT）辅助激光治疗性角膜切削术（excimer laser phototherapeutic keratectomy， PTK）治疗非Ⅱ型颗粒状角膜营养不良的初步临床效果。方法：回顾性病例系列研究。选取2011-04/2013-01在沈阳何氏眼科医院门诊诊断为颗粒状角膜营养不良的患者8例12眼，接受PTK手术，术前以Avellino角膜营养不良快速诊断试剂盒检测均排除了Ⅱ型颗粒状角膜营养不良（即Avellino角膜营养不良），术前均进行眼前节OCT检查，辅助判断病变形态和深度，指导PTK术中切削深度等参数的设定。对手术后并发症、术后复发、视力恢复等进行随访。结果：术后随访6～12（平均9）mo。所有患者术后最佳矫正视力均明显提高，术后角膜浅层混浊病灶均得到了有效的切削，术后随访期内所有患者均未出现角膜混浊灶复发或严重haze情况的发生。结论：对于非Ⅱ型颗粒状角膜营养不良的患者，眼前节OCT辅助的PTK术可准确、有效的去除角膜病灶，获得较好的术后效果。

眼前节OCT辅助PTK治疗角膜浅层病变的临床观察

目的探讨眼前节相干光层析成像术(OCT)辅助治疗性角膜光学切削术(PTK)治疗角膜浅层病变的疗效。方法分析在我院经眼前节OCT辅助PTK治疗的角膜浅层病变患者15例(20只眼)的临床资料。术前均行眼前节OCT检查,判断病变的形态和深度,指导PTK削融方案的制定,并对术前、术后6个月内的角膜上皮愈合情况、裸眼视力(UCVA)、最佳矫正视力(BCVA)、角膜病变深度、角膜厚度、并发症等进行观察。结果所有患者的角膜浅层病变在安全范围内均得到了有效切削,术后1、3、6个月UCVA及BCVA较术前均有显著提高(P<0.05),术后3个月较术后1个月UCVA和BCVA均有显著提高(P<0.05),术后6个月患者UCVA和BCVA基本稳定。未见原发病复发及严重并发症的发生。结论眼前节OCT能对角膜浅层病变进行准确的检测,从而指导PTK治疗,术后效果好,并发症少。眼前节OCT辅助PTK治疗角膜浅层病变具有安全性和有效性,值得临床推广。

准分子激光PTK治疗复发性角膜上皮糜烂

目的:探讨准分子激光治疗性角膜切削术(excimer laser phototherapeutic keratectomy,PTK)治疗角膜上皮糜烂的方法和疗效。方法:选择9例11眼复发性角膜上皮糜烂(recurrent corneal erosiou)患者,行准分子激光治疗性角膜切削术(PTK),戴治疗性角膜接触镜5~7d,随访3mo^3a。结果:9例11眼中8例10眼一次性痊愈,1例1眼再次PTK治疗痊愈。结论:PTK是治疗复发性角膜上皮糜烂简便有效的方法。

用PTK及机械方法去除角膜上皮对PRK进行观察

目的:分别使用光性治疗性角膜切除术(PTK)和机械方法去除角膜上皮,观察光性屈光性角膜切削术(PRK)术后症状、角膜上皮愈合及haze发生情况。方法:2001-02~2003-03期间对122人214眼屈光度在-1.50D^-5.00D之间的近视病人分别使用PTK和机械方法去除角膜上皮行PRK手术。结果:PTK去除角膜上皮较机械方法去除角膜上皮,病人术后症状明显减轻,前者角膜上皮较后者愈合快,且无一例haze发生,而后者发生5例。结论:PTK去除角膜上皮行PRK手术,术后症状轻、角膜上皮愈合快及haze发生少,值得推广应用。

Treatment of superficial corneal opacities with corneal stromal lenticule obtained through SMILE surgery

AIM:To evaluate the clinical efficacy and feasibility of superficial corneal opacities treated by excimer laser phototherapeutic keratectomy(PTK)combined with small incision lenticule extraction(SMILE)-derived corneal stromal lenticule transplantation.METHODS:A retrospective interventional case series of nine patients aged 12-59y with superficial corneal opacity caused by different pathologies who underwent standardized PTK combined with SMILE-derived corneal stromal lenticule transplantation was examined.Lenticule patches were fixed with fibrin glue.All patients underwent pre-and post-operative clinical assessments at different times for up to 12mo.Slit lamp microscopy,corneal density,uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),and anterior segment optical coherence tomography(AS-OCT)were examined.RESULTS:The patients’mean age was 36.00±5.80(12-59)y.Seven eyes(77.8%)gained UDVA and CDVA at the last measurement compared to their preoperative levels.The densities of the total cornea,the total anterior corneal layer,and the anterior corneal layers of 0-2 and 2-6 mm decreased significantly by 12.4%,27.5%,46.7%,and 32.8%,respectively.After human allogeneic transplantation,the implanted lenticules of all eyes were clearly visible by AS-OCT and remained transparent without displacement or graft rejection.The thickness of the central cornea and corneal lenticule transplants were stable throughout the entire postoperative period.One case experienced the postoperative complication of delayed corneal epithelial healing.CONCLUSION:PTK combined with SMILE-derived corneal lenticule transplantation improves long-term visual acuity.Therefore,it is a new,safe,and effective method for treating superficial corneal opacity.

PTK在再次准分子激光角膜切削术中的应用

目的 探讨用PTK技术矫治因PRK术后出现的严重不规则角膜散光并欠矫的方法 ,观察其疗效。方法 参考角膜地形图 ,先使用阻滞剂粘弹剂保护角膜凹面再行PTK术 ,得到光滑的角膜表面后 ,再次准分子激光角膜切削术。结果 3例 5眼均获得良好的疗效 ,术后裸眼视力 1 0 ,角膜透明。随访 2年疗效巩固 ,手术前后的角膜地形图可以证明。结论 采用PTK技术治疗因PRK术出现的不规则散光是有效的。

Transepithelial photorefractive keratectomy mode using SCHWIND-ESIRIS excimer laser:initial clinical results

AIM: To evaluate postoperative pain, uncorrected visual acuity (UCVA), and cornea haze value after transepithelial photorefractive keratectomy (T-PRK) performed with aspherical ablation profile using SCHWIND ESIRIS excimer laser. METHODS: Retrospective case series. Fifty-nine eyes (32 patients) with myopia associated with or without astigmatism underwent phototherapeutic keratectomy (PTK) followed by photorefractive keratectomy (PRK) which performed by Optimized Refractive Keratecomy (ORK)-CAM software based on aspherical ablation profile using SCHWIND ESIRIS excimer laser. Postoperative pain scale was measured on a questionnaire through five levels. Haze was graded by five grades, and UCVA, manifest refraction spherical equivalent (MRSE) were analyzed. RESULTS: Mean pain level was (1.37 +/- 0.613) (range: 1 to 3), the mean time picking out the soft contact lens was (6.22 +/- 1.73) days, at 3 months, UCVA was 1.0 for 40 eyes (67.8%), 0.5 for all eyes (100.0%). The UCVA was significantly less than the preoperative best spectacle corrected visual acuity (BSCVA) (t=-2.84, P=0.006), haze value was (0.27 +/- 0.25), no patients had a haze grade up to 2. Mean MRSE was (0.76 +/- 0.96) diopter(D) by 3 months. CONCLUSION: The outcomes from this study show that using the SCHWIND ESIRIS aspherical ablation profile for transepithelial PRK has a good visual result. The primary advantage is related to a spherical ablation profile, automatically considers the ablation volume of the stroma and the accurate and smooth removal of the epithelium with PTK. Additional studies are needed to determine long-term outcomes.

PTK-PRK-CXL和PTK-CXL治疗LASIK术后角膜膨隆的疗效

目的评价准分子激光治疗性角膜切削术(phototherapeutic keratectomy,PTK)联合角膜交联(corneal cross-linking,CXL)术(PTK-CXL)和准分子激光治疗性角膜切削术、准分子激光屈光性角膜切削术(photorefractive keratectomy,PRK)联合CXL术(PTK-PRK-CXL)治疗准分子激光原位角膜磨镶术(laser in situ keratomileusis,LASIK)术后角膜膨隆的临床效果。方法选取LASIK术后角膜膨隆的患者28例(40眼),根据手术方式不同分为PTK-CXL组和PTK-PRK-CXL组。分别在治疗前及治疗后6个月、12个月测量患者的视敏度、屈光度、最大角膜曲率(maximum keratometry,K max)、最薄点角膜厚度(thinnest corneal thickness,TCT)、角膜内皮细胞计数(endothelial cell count,ECC)。将术后不同时间点的观察结果与术前做自身对照,并比较两组不同观察指标的变化量差异。结果两组均能有效降低患者的角膜曲率和屈光度,提高患者的视敏度,对角膜内皮细胞无影响。PTK-CXL组和PTK-PRK-CXL组裸眼视力术后6个月分别为(0.59±0.35)logMAR、(0.22±0.10)logMAR;术后12个月分别为(0.56±0.32)logMAR、(0.17±0.11)logMAR。两组K max术前分别为(55.51±8.08)D、(52.59±6.30)D,术后6个月降低为(54.07±8.07)D、(46.55±5.04)D;术后12个月为(53.96±8.01)D、(46.12±4.94)D。除PTK-CXL组柱镜度数在术后6个月、12个月与术前相比,差异均无统计学意义(均为P>0.05)外,两组其他观察指标在术后不同时间点与术前相比,差异均有统计学意义(均为P<0.05)。两组ECC均在术后12个月恢复至术前水平,与术前差异均无统计学意义(均为P>0.05)。两组术后不同时间点各观察指标相较于术前的变化量,除BCVA外,其他指标变化量差异均有统计学意义(均为P<0.05)。结论PTK-CXL和PTK-PRK-CXL均能安全有效控制角膜膨隆的进展,PTK-PRK-CXL较PTK-CXL能更好地改善患者的裸眼视力,角膜曲率的降低更显著。

PTK联合绷带镜在原发性翼状胬肉中的应用

目的探讨翼状胬肉的治疗方法。方法回顾性收集30例(40只眼)原发性翼状胬肉切除术患者临床资料,按照不同手术类型将其分为两组,实验组20只眼行PTK+绷带镜+原发性翼状胬肉切除联合自体结膜移植术,对照组20只眼行原发性翼状胬肉切除联合自体结膜移植术。术后随访6个月观察两组角膜上皮愈合情况、角膜刺激症状程度、BUT和复发率。结果实验组术后1、7 d角膜刺激症状评分均低于对照组(P<0.01),角膜上皮愈合时间快于对照组(P<0.01);两组BUT差异有统计学意义(P<0.05)。结论在治疗原发性翼状胬肉中,PTK联合绷带镜能明显减轻患者术后角膜刺激症状,促进患者角膜上皮修复。

Treatment of anterior corneal scarring,following DSAEK graft failure,with combined graft exchange and phototherapeutic keratectomy

Background:To present a method,alternative to penetrating keratoplasty,for the restoration of impaired corneal clarity with anterior stromal scarring following long-standing corneal graft failure.Case presentation:A 48-year old female who had previously underwent Descemet stripping automated endothelial keratoplasty(DSAEK)for the treatment of pseudophakic bullous keratopathy,presented with longstanding corneal oedema and anterior corneal scarring.A significant improvement in corrected distance visual acuity was demonstrated,as corneal clarity was restored following graft exchange and phototherapeutic keratectomy(PTK).Conclusions:The combination of corneal graft exchange and phototherapeutic keratectomy may represent an effective therapeutic option for long-standing corneal oedema with concomitant anterior corneal scarring after failure of a DSAEK graft.

外傷性複發性角膜上皮糜爛的治療分析

目的回顧性分析外傷性複發性角膜上皮糜爛採用藥物治療或酒精輔助去角膜上皮準分子激光治療性角膜切削術(A-PTK)的療效。方法回顧性病例研究。取2019年3月~2022年10月在本院診斷外傷性複發性角膜上皮糜爛患者78眼,觀察其臨床表現、治療方法及複發率、複發間隔等。對於經A-PTK治療的患者,進行為期6個月的術後觀察,包括複發率、複發間隔及有無手併發症等。並對A-PTK手術酒精浸泡時間、切削深度與複發率有無相關性等進行分析。結果(1)本研究共入組78眼,男性32眼(41%),女性46眼(59%);整體發作間隔天數為123.04±115.93天,男性平均發作間隔天數77.88±72.65天,女性154.46±130.0天。Spearman's相關係數分析結果顯示,男性較女性複發的間隔更短(P<0.001)。(2)藥物治療組64眼,在數據收集期複發率為48.4%。A-PTK組14眼,術後6個月内複發率為28.6%。(3)A-PTK治療組患者在術後的6個月隨訪結束時視力均恢復到術前水準。有一例患者術後出現-0.50DS近視,戴鏡矯正1.0。無一例發生HAZE。(4)經A-PTK治療的患者,其治療後的發作間隔天數(144.36±66.03天),明顯比治療前(52.43±41.98天)延長,有統計學意義(P=0.004)。結論本研究外傷性複發性角膜上皮糜爛的病例,男性比女性複發更頻密;A-PTK治療外傷性複發性角膜上皮糜爛可以減少複發的頻率,是治療頻繁複發外傷性角膜上皮糜爛有效和安全的治療方法。

准分子激光治疗性角膜切削术在初发性翼状胬肉治疗中的应用

目的评价准分子激光治疗性角膜切削术(phototherapeutic keratectomy,PTK)联合丝裂霉素C(mitomycin C,MMC)治疗初发性翼状胬肉的临床疗效。方法回顾分析2005-06/2011-02月行PTK治疗的初发性翼状胬肉患者126例140眼,在手术显微镜下分离及切除胬肉及变性球筋膜组织,结膜下置0.4 mg/ml MMC棉球2 min,彻底冲洗后使用193 nm准分子激光行PTK切削残余病变组织。术后均使用相应的局部抗菌及激素滴眼液巩固治疗。术后随访观察至少1年以上。观察术后上皮愈合情况,记录视力恢复、角膜散光度数及胬肉复发情况。结果 PTK平均切削直径(3.86±0.89)mm,平均切削深度(94.21±23.29)μm。术后患眼反应轻,平均上皮愈合时间(2.88±0.83)天。平均随访(17.9±5.4)月,3例患者(4眼)胬肉复发,复发率为2.5%。随访结果:术后裸眼视力较术前均有显著提高,差异具有统计学意义(P<0.01);术后角膜散光度数较术前均有显著降低,差异有统计学意义(P<0.01)。结论PTK作为一种微创的手术方法,可以安全、有效的清除角膜上残留的胬肉及变性组织,重建角膜表面的光滑平整性,有利于创面角膜上皮修复,减少角膜散光,从而改善视功能。其与MMC的联合应用,能有效地降低翼状胬肉的术后复发率。

前节OCT辅助准分子激光治疗性角膜切削术治疗真菌性角膜溃疡

目的评价前节OCT辅助准分子激光治疗性角膜切削术(excimer laser phototherapeutic,PTK)治疗真菌性角膜溃疡的临床效果。方法回顾性分析已确诊为真菌性角膜溃疡且应用局部和全身抗真菌药物治疗7d后无效或病情加重的24例(24眼)患者,角膜溃疡深度均未超过1/3角膜厚度,将患者分为两组,治疗组接受前节OCT辅助的PTK治疗,共14例(14眼),对照组采用角膜病灶板层切除手术治疗,共10例(10眼)。随访至少6个月。记录治疗前后最佳矫正视力(best corrected visual acuity,BCVA)、角膜厚度、共焦显微镜检查情况。观察术后角膜上皮修复时间、治疗时间及并发症情况。结果两组术后BCVA均较术前明显提高,差异均有统计学意义(均为P<0.01),治疗组BCVA提高程度明显优于对照组,差异有统计学意义(P<0.05)。治疗组术后治疗持续时间为(19.43±5.68)d,短于对照组的(34.40±5.38)d,差异有统计学意义(P<0.05)。治疗组术后剩余角膜厚度与对照组相比差异无统计学意义(P>0.05)。共焦显微镜检查亦治疗组术后残余菌丝较对照组明显减少。治疗组术后上皮修复时间为(4.00±1.11)d,短于对照组的(6.20±1.39)d,差异有统计学意义(P<0.05)。随访期内,治疗组术后无一眼复发,对照组术后0.5 a有3眼复发,1眼药物控制有效,另2眼病情加重,进一步行角膜移植手术。结论前节OCT辅助PTK治疗真菌性角膜溃疡可以有效清除病灶、加速上皮愈合,为治疗早期浅层真菌性角膜溃疡提供了一个全新的选择。

常规手术联合准分子激光角膜切削术治疗翼状胬肉

目的临床观察验证准分子激光角膜切削术(phototherapeutic keratectomy,PTK)在翼状胬肉治疗中的临床实用意义。方法随访性良好的原发性翼状胬肉患者30例(35眼),常规翼状胬肉切除术联合准分子激光切削术治疗翼状胬肉。术后随访6个月,临床观察翼状胬肉术后复发情况、术后角膜上皮生长修复速度、schirmer试验(ST)、泪膜破裂时间(BUT)、角膜散光(电脑验光及角膜地形图)、患眼术后不适感程度。结果在30例翼状胬肉患者中,随访6个月,术眼术区没有复发体征。结论准分子激光角膜切削术(PTK)是一种有效预防翼状胬肉术后复发的手术措施。

准分子激光治疗浅层角膜变性(英文)

目的 探讨准分子激光PTK治疗多种浅层角膜变性 (SCD)的效果。 方法 用MEL 60准分子激光机对 2 6只SCD眼行PTK治疗 ,随访 6～ 18个月。 结果 术后 4～ 15天角膜上皮完全愈合。 2 4眼 (92 % )的最佳矫正视力提高。其中 3眼 (12 % )提高 8行、6眼 (2 3 % )提高 5行、7眼 (2 7% )提高4行、6眼 (2 3 % )提高 3行、2眼 (8% )提高 2行、2眼无变化。2 0眼术后有远视改变。 结论 PTK治疗SCD安全有效 ,近期成功率高、并发症少 。

准分子激光光学治疗性角膜切削术治疗真菌性角膜溃疡

目的观察使用准分子激光光学治疗性角膜切削术（PTK）治疗浅层真菌性角膜溃疡的临床效果。方法确诊为真菌性角膜溃疡并对药物治疗不敏感，且溃疡深度均未超过1／3角膜厚度者11例（11眼），使用193nm准分子激光行PTK治疗消融病变角膜组织，并与8例病情程度相似，但使用常规清创术和角膜组织切除术治疗的浅层真菌性角膜溃疡对比疗效。两组病例术后均使用局部抗真菌滴眼液巩固治疗。结果PTK治疗组术后无复发，PTK组治疗时间（25．27±5．83）天明显短于对照组的治疗时间（42．75±17．90）天，（P〈0．05）。PTK组术后3月最佳矫正视力为0．1～1．0，较术前平均上升了（2．36±1．36）行，明显优于对照组（0．75±1．04）行治疗效果。结论使用PTK治疗药物治疗效果不佳的浅层角膜溃疡，能有效缩短治疗时间，并能获得较好的术后视力，治疗效果好而并发症较少。

神经生长因子对准分子激光治疗性角膜切削术后角膜修复的作用

目的探讨神经生长因子(nerve growth factor,NGF)对准分子激光治疗性角膜切削术(phototherapeutic keratectomy,PTK)后伤口愈合及透明度恢复的影响。方法建立30只新西兰白兔PTK模型,术后右眼滴用自制NGF滴眼液,左眼滴用人工泪液作为对照眼。于术后不同时间分别进行裂隙灯、光学显微镜、722光栅分光光度计及扫描电镜检查。结果2组均于术后3～7d角膜上皮全部愈合,差异无统计学意义(P>0.05)。实验组术后不同波长的角膜透明度高于对照组,差异有统计学意义(P<0.05)。HE染色光镜观察发现对照组上皮细胞过度增生较重。扫描电镜显示,术后4周NGF组角膜上皮细胞层基本恢复正常,对照组角膜上皮表面的微绒毛及微皱褶仍然相对较少。结论NGF通过改善伤口愈合的微环境,抑制角膜上皮细胞的过度增生,调节伤口愈合,从而促进PTK后角膜透明度的恢复。