CAJ | 학술논문

目的观察穿透性角膜移植治疗准分子激光原位角膜磨削术(Laserin situkeratomileusis,LASIK)术后继发圆锥角膜的效果.方法对6例LASIK术后确诊为继发圆锥角膜的患者进行穿透性角膜移植术,选用直径7～7.5mm植片,与植床等大.术后随访1～5年,观察和评价其疗效.结果本研究6例患者LASIK术前角膜厚度平均为394.9μm.术后圆锥发生时间(13±3.4)个月,穿透性角膜移植术后,中央角膜厚度平均为504.7μm,视力明显增进,随访期内未见圆锥角膜复发.讨论我们建议,进行LASIK对术中切削时,角膜基质床的厚度不应小于270μm,角膜总厚度不应小于400μm.对LASIK术后继发圆锥角膜患者行穿透性角膜移植术,植床直径与角膜植片等大,术后再选择性拆除缝线,将有助于降低术后免疫排斥反应发生率和圆锥复发,减少手术源性散光,提高视力.
목적 관찰천투성각막이식치료준분자격광원위각막마삭술(Laserin situkeratomileusis,LASIK)술후계발원추각막적효과.방법 대6례LASIK술후학진위계발원추각막적환자진행천투성각막이식술,선용직경7～7.5mm식편,여식상등대.술후수방1～5년,관찰화평개기료효.결과 본연구6례환자LASIK술전각막후도평균위394.9μm.술후원추발생시간(13±3.4)개월,천투성각막이식술후,중앙각막후도평균위504.7μm,시력명현증진,수방기내미견원추각막복발.토론아문건의,진행LASIK대술중절삭시,각막기질상적후도불응소우270μm,각막총후도불응소우400μm.대LASIK술후계발원추각막환자행천투성각막이식술,식상직경여각막식편등대,술후재선택성탁제봉선,장유조우강저술후면역배척반응발생솔화원추복발,감소수술원성산광,제고시력.
Objective To investigate the therapeutic effect of penetrating keratoplasty (PKP) for secondary keratoconus after Laser in situ keratomileusis (LASIK). Methods Six eyes of secondary keratoconus after LASIK undergoing PKP were analyzed with 7.5mm transplant which had the same diameter that positively matching the recipient bed. The therapeutic effect had been monitored and assessed for the follow-up 1 to 5 years. Results Post-operatively, the six patients had an average 504.7+8.3μ m of central cornea thickness.The visual acuity improved obviously and there was no recurrence of keratoconus during the follow-up period.Conclusions It is encouraged that during the PKP, the thickness of stromal bed should be less than 270μ m,and the overall thickness of cornea after photoablation should be greater than 400μ m. For the ectatic corneas followed by LASIK, it is essential to replace the abnormal cornea by a same diameter donor button, and the sutures will be removed under the guidance of corneal topography. A lower occurrence of immunological rejection, iatrogenic astigmatism and good vision would be expected to occur.