VisuMax飞秒激光辅助的穿透性角膜移植16例临床效果

目的 观察16例VisuMax飞秒激光辅助的穿透性角膜移植临床效果。方法 回顾性病例研究。16例（16眼）患者在南京军区南京总医院眼科行VisuMax飞秒激光辅助的穿透性角膜移植术。500 kHz飞秒激光进行供体及受体角膜的90°垂直边切。主要评价指标包括裸眼视力（UCVA）、最佳矫正视力（BCVA）、散光度、角膜厚度及内皮细胞计数等。随访时间为（9.6±5.6）个月。结果 所有手术顺利完成。UCVA从术前的光感～0.15提高到术后的手动～0.5,BCVA从术前的光感～0.3提高到术后的手动～0.8,平均散光度为（2.91±2.57）D,中央角膜厚度为（554.9±23.3）µm,角膜内皮细胞密度为（2 433±322）cells/mm2。结论 VisuMax飞秒激光辅助的穿透性角膜移植由于切口对合精确,术后视力恢复快,散光较小,视力较术前均有不同程度的提高。     

Outcomes of femtosecond laser-assisted penetrating keratoplasty

PURPOSE: To evaluate outcomes from the use of a femtosecond laser to trephine both donor and recipient corneas during penetrating keratoplasty (PK). DESIGN: Prospective interventional case series. METHODS: Patients were recruited from the cornea clinic of the Singapore National Eye Centre. We used a 10-kHz Femtec (20/10 Perfect Vision, Heidelberg, Germany) femtosecond laser to perform trephination of the donor cornea on an artificial anterior chamber, followed by trephination of the recipient cornea. Trephination cuts were straight and performed 90 degrees to the corneal surface. Tissue bridges were bluntly separated with a Barrett phaco chopper. The donor button was then sutured to the recipient with double continuous sutures, or interrupted sutures if significant host corneal vascularization was present. Postoperatively, visual acuity, refraction, intraocular pressures, and optical coherence tomography (Visante; Carl Zeiss, Jena, Germany) were evaluated. RESULTS: Eight eyes of eight patients underwent PK for conditions ranging from bullous keratopathy to corneal scarring from herpetic stromal keratitis. Patients were followed up for a mean of 9.5 months. Best-corrected visual acuities of patients with no ocular comorbidity ranged from 20/20 to 20/80. Mean cylindrical refractive error at last review was 2.56 diopters [D] (range, 0.50 to 4.00 D). Tissue bridges were bluntly dissected except for one case that required scissors completion of trephination. No complications were encountered related to use of the Femtec laser. CONCLUSION: The Femtec laser reliably trephines both donor and recipient corneas for PK, with good visual outcomes and relatively low degrees of astigmatism.     

飞秒激光辅助白内障手术的临床评价研究

飞秒激光白内障手术系统投入临床应用已经4年,目前飞秒激光主要应用于手术的三个关键步骤：环形撕囊、晶状体核劈开和角膜切口.近年来研究者的目光越来越多聚焦在它的安全性及新的应用上来,如飞秒激光与传统超声乳化对比,术后角膜内皮丢失及角膜厚度的改变,术后房闪、视网膜增厚情况等,有学者运用飞秒激光白内障手术系统植入成年人BIL （bag-in-the-lens）型人工晶状体,或将飞秒激光及纳秒激光手术系统联合,使得整个白内障手术过程实现完全“无刀”.本文介绍并比较了四种设备的特点,并就飞秒激光白内障手术系统临床应用的安全性、有效性、局限性以及其学习曲线和最新的临床应用进展进行综述.     

Outcomes of femtosecond laser-assisted Descemet membrane endothelial keratoplasty for failed penetrating keratoplasty

ObjectiveTo analyze the outcomes of femtosecond laser-enabled Descemet membrane endothelial keratoplasty (FE-DMEK) in treatment of failed penetrating keratoplasty (PK) grafts.Study DesignRetrospective, interventional case series.ParticipantsPatients with a failed PK graft who underwent FE-DMEK at Toronto Western Hospital, Canada, between 2014 and 2016.MethodsOutcome measures were best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), rates of graft detachment, rebubbling, rejection, and failure.ResultsEight eyes of 8 patients were included. Mean age was 64.7 ± 14.5 years. Average follow-up time was 27.5 ± 8.6 months (range 15–36 months). There were no intraoperative complications and no issues with the creation of the descemetorhexis—all descemetorhexis cuts were complete. There were no significant graft detachments and no need for rebubbling. There were no primary or secondary graft failures and all grafts were viable at the final follow-up. BSCVA worsened from 0.41 ± 0.33 logMAR (Snellen equivalent ∼20/50) to 1.37 ± 0.91 logMAR (Snellen equivalent ∼20/460) after PK failure (p = 0.012), and improved significantly after FE-DMEK to 0.34 ± 0.14 logMAR (Snellen equivalent ∼20/45), 0.42 ± 0.12 logMAR (Snellen equivalent ∼20/50), 0.27 ± 0.14 logMAR (Snellen equivalent ∼20/35), and 0.25 ± 0.16 logMAR (Snellen equivalent ∼20/35) at 6 months, 12 months, 24 months, and at final follow-up, respectively (p = 0.013, p = 0.027, p = 0.022, and p = 0.008, respectively). ECD decreased from 2837 ± 229 cells/mm² preoperatively to 1069 ± 413 cells/mm² (61.4% cell-loss rate) and 974 ± 344 cells/mm² (64.8% cell-loss rate) at 12 months and 24 months, respectively (p < 0.001). Cell loss was higher than in historical controls.ConclusionsFE-DMEK was effective in the management of PK graft failure, showing very low detachment and rebubble rates.     

飞秒激光辅助白内障超声乳化术中患者眼球旋转的临床观察

目的　探讨飞秒激光辅助白内障超声乳化术（FLACS）中眼球旋转的规律。方法　前瞻性分析2018年1月至2021年1月行FLACS的患者679例（775眼）的临床资料。术前应用VERION数字导航系统在坐位时采集术眼眼前节图像,术中应用配有VERION数字导航系统的Alcon LenSx飞秒激光手术设备获取患者仰卧位时眼前节图像,记录术中眼球旋转的方向和角度。结果　775眼中,719眼（92.77%）发生了旋转,内旋最多见。患者逆时针旋转度数（5.08°±3.49°）大于顺时针旋转度数（4.29°±2.85°）,差异有统计学意义（P=0.001）。患者内旋度数（5.12°±3.38°）大于外旋度数（3.86°±2.67°）,差异有统计学意义（P<0.001）。患者右眼与左眼相比,顺时针及逆时针旋转发生率、旋转度数、顺时针旋转度数、逆时针旋转度数、内旋度数差异均有统计学意义（均为P<0.05）。男性患者外旋度数（4.58°±3.14°）大于女性患者（3.37°±2.18°）,差异有统计学意义（P=0.001）。年龄＜50岁患者和年龄≥50岁患者相比,眼球旋转方向和旋转度数差异均无统计学意义（均为P>0.05）。结论　FLACS手术中,眼球普遍存在一定程度的旋转,眼球旋转的规律主要与眼别有关。VERION数字导航系统的应用可以使飞秒激光角膜切开术更加精确。     

飞秒激光辅助的穿透性角膜移植术临床疗效观察

目的观察应用飞秒激光技术辅助行穿透性角膜移植手术（FS．PKP）的初步临床疗效。方法回顾性病例研究。分析6例（6眼）行FS—PKP术的患者,术前视力从手动到0．05不等,病变均累及角膜全层。根据病变性质及范围不同,利用飞秒激光制作不同形状的植片和植床,2例患者行Zig—Zag（之字形）切割,1例行Zig-Square（上方之字形,下方方形）切割,1例行蘑菇形切割,2例行礼帽型切割。术后均按常规穿透性角膜移植术进行治疗。结果随访期间,视力均较术前有不同程度提高,视力达0．5及以上者3例．其中1例患者视力恢复至1．0。术后1年时6例患者散光值在2．25～5．00D之间。1例Zig．Zag型切割患者术中发生偏中心切割,术后10个月完全拆线后行飞秒激光散光矫正术;1例礼帽型切割角膜移植患者术后早期出现高眼压。余患者未见明显并发症。结论应用FS-PKP术治疗角膜病变,可操作性强,切削精确,瘢痕轻,术后散光小。     

Corneal astigmatic outcomes after femtosecond laser-assisted cataract surgery combined with surface penetrating arcuate keratotomies

AIM: To evaluate corneal astigmatic outcomes of femtosecond laser-assisted arcuate keratotomies (FAKs) combined with femtosecond-laser assisted cataract surgery (FLACS) over 12mo follow-up.METHODS: Totally 145 patients with bilateral cataracts and no ocular co-morbidities were recruited to a single-centre, single-masked, prospective randomized controlled trial (RCT) comparing two monofocal hydrophobic acrylic intraocular lenses. Eyes with corneal astigmatism (CA) of >0.8 dioptres (D) received unpaired, unopened, surface penetrating FAKs at the time of FLACS. Visual acuity, subjective refraction and Scheimpflug tomography were recorded at 1, 6, and 12mo. Alpins vectoral analyses were performed.RESULTS: Fifty-one patients (61 eyes), mean age 68.2±9.6y [standard deviation (SD)], received FAKs. Sixty eyes were available for analysis, except at 12mo when 59 attended. There were no complications due to FAKs. Mean pre-operative CA was 1.13±0.20 D. There was a reduction of astigmatism at all post-operative visits (residual CA 1mo: 0.85±0.42 D, P=0.0001; 6mo: 0.86±0.35 D, P=0001; and 12mo: 0.90±0.39, P=0.0001). Alpins indices remained stable over 12mo. Overall, the cohort was under-corrected at all time points. At 12mo, 61% of eyes were within ±15 degrees of pre-operative astigmatic meridian.CONCLUSION: Unpaired unopened penetrating FAKs combined with on-axis phacoemulsification are safe but minimally effective. CA is largely under-corrected in this cohort using an existing unmodified nomogram. The effect of arcuate keratotomies on CA remained stable over 12mo.     

Postoperative astigmatism after central vs eccentric penetrating keratoplasties

Six patients with markedly eccentric penetrating keratoplasties had severe corneal astigmatism (mean, 10.38 +/- 2.91 diopters). In four of these patients the flat meridian was lying in the direction of graft displacement. Laboratory experiments disclosed no statistically significant difference in diameter between the major and minor axes of the corneal buttons in the centrally and eccentrically trephined eyes and we could not elucidate the mechanism of the severe astigmatism. However, in the eccentrically trephined eyes the longer axis consistently lay in the direction of decentration whereas in the centrally trephined eyes the long axis was oriented randomly.     

Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery

Purpose

To examine the clinical utility of femtosecond laser-assisted astigmatic keratotomy (FSL-AK) for eyes after cataract surgery.

Methods

Eight eyes of 6 patients with an intraocular lens and corneal astigmatism of 2.0 diopters (D) or more underwent FSL-AK. The mean preoperative manifest cylindrical refraction was 2.88 ± 0.64 D and the mean corneal astigmatism was 2.84 ± 0.83 D. Paired symmetrical arcuate incisions were created with the same settings, except for the incision depth. Uncorrected distance visual acuity (UDVA), manifest cylindrical power, and surgically induced astigmatism (SIA) were measured at 1 day, 1 week, and 1 month postoperatively. Fourier analysis of corneal topography and incision depths measured with anterior-segment optical coherence tomography were evaluated 1 month postoperatively.

Results

In all eyes, the UDVA improved at 1 week and 1 month postoperatively, and the manifest cylinder also decreased postoperatively, while the SIA showed overcorrections in 6 eyes. Fourier analysis showed decreases in spherical and regular astigmatic components and increases in higher-order irregularity. The mean incision depth was measured as 60 µm deeper than the intended depth.

Conclusion

The FSL-AK effectively reduced corneal astigmatism and improved the UDVA, although it was demonstrated that the deeper incisions led to overcorrection.

     

飞秒激光在角膜移植中的应用进展

飞秒激光有高精度的切削特点,使其在角膜移植方面有着巨大的应用潜力,它可以替代机械角膜刀,根据临床需要制作不同形状的角膜植片和植床,适用于穿透性角膜移植、板层角膜移植和角膜内皮细胞移植等手术。飞秒激光的出现为改进和优化各种角膜移植手术方式提供了新的途径,本文将就飞秒激光在角膜移植方面的应用进展做一综述。