[1]陆燕,朱小敏,曹谦,等.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[J].眼科新进展,2015,35(1):035-38.[doi:10.13389/j.cnki.rao.2015.0010]
　LU Yan,ZHU Xiao-Min,CAO Qian,et al.Comparison of two surgical techniques of femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus[J].Recent Advances in Ophthalmology,2015,35(1):035-38.[doi:10.13389/j.cnki.rao.2015.0010]
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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
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
35卷
期数:
2015年1期
页码:
035-38
栏目:
应用研究
出版日期:
2015-01-05

文章信息/Info

Title:
Comparison of two surgical techniques of femtosecond laser-assisted deep anterior lamellar keratoplasty for keratoconus
作者:
陆燕; 朱小敏; 曹谦; 段娴艺; 陈祥菲; 杨丽萍; 黄振平
２１０００２　江苏省南京市，南京军区南京总医院眼科
Author(s):
LU Yan ;  ZHU Xiao-Min;  CAO Qian;  DUAN Xian-Yi;  CHEN Xiang-Fei;  YANG Li-Ping ;  HUANG Zhen-Ping
Department of Ophthalmology,Nanjing General Hospital of Nanjing Military Command PLA, Nanjing 210002,Jiangsu Province,China
关键词:
深板层角膜移植; 圆锥角膜; 飞秒激光
Keywords:
deep anterior lamellar keratoplasty ;  keratoconus ;  femtosecond laser
DOI:
10.13389/j.cnki.rao.2015.0010
文献标志码:
A
摘要:
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（ｄｅｅｐａｎｔｅｒｉｏｒｌａｍｅｌｌａｒｋｅｒａｔｏｐｌａｓｔｙ，ＤＡＬＫ）（ｐｒｅＤｅｓｃｅｍｅｔｉｃＤＡＬＫ）和飞秒激光联合Ａｎｗａｒ大气泡技术切除全部基质层ＤＡＬＫ（ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ）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ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ，８例１０眼行飞秒激光辅助的Ａｎｗａｒ大气泡ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ，术后随访１ａ，比较２组术后最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｅｄｖｉｓｕａｌａｃｕｉｔｙ，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１ａ，ｐｒｅＤｅｓｃｅｍｅｔｉｃＤＡＬＫ组ＢＣＶＡ为０．５２±０．２４，ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ组ＢＣＶＡ为０．４９±０．１９，差异无统计学意义（Ｐ＝０．７５８）；ｐｒｅＤｅｓｃｅｍｅｔｉｃＤＡＬＫ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，ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ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ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ组为（４４．３０±４．１８）Ｄ，ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ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ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ组为（４８３．４０±５３．７０）μｍ，ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ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ＤｅｓｃｅｍｅｔｉｃＤＡＬＫ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。
Abstract:
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 exanunation . 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 ) ym and ( 471. 5 + 41. 68 ) ym in the pre-Descemetic DALK and Descemetic DALK groups, respectively (P = 0. 587) . Conclusion The patients who underwent the Descemetic femtosecond laser-assisted DALK technique show postoperative low myopia , and can be considered as the better surgical technique for moderate and advanced keratoconus.

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备注/Memo

备注/Memo:
国家自然科学基金面上项目（编号：８１２７０９７９）；江苏省自然科学基金面上项目（编号：ＢＫ２０１２７７７）
更新日期/Last Update: 2015-01-04