CAJ | 학술논문

目的：评价应用飞秒激光辅助穿透性角膜移植术( FS-PKP)的早期疗效及安全性。 　　方法：回顾性分析46例48眼FS-PKP术病例。术前最佳矫正视力为2.35±1.01(标准对数视力表),角膜病变累及全层,包括圆锥角膜、白斑、外伤性瘢痕等。采用飞秒激光制作不同直径和边缘形状的全层角膜植片与对应植床,进行角膜移植术,术后治疗与常规穿透性角膜移植术(传统PKP)相同。评价指标包括术前及术后1,6,10mo的裸眼视力( UCVA)、最佳矫正视力( BCVA)、角膜散光( CA)值、手术并发症。将同期完成的43例44眼传统PKP病例作为对照组。两组数据采用统计软件SPSS 18.0成组设计的两样本均数比较和χ2检验。 　　结果：所有手术均顺利完成,术后视力均有不同程度的提高；在与传统PKP的比较中,两种术式的术后UCVA在术后1mo时分别是3.48±0.43和2.97±1.14,有显著的统计学差异(P=0.009)；术后3mo时UCVA分别是3.86±0.25和3.74±0.73,术后6mo时分别是4.04±0.23和3.98±0.29,均无统计学差异( P=0.146, P=0.56)；FS-PKP组术后1 mo BCVA优于传统PKP手术组,差异有显著统计学意义(P=0.002),而术后6,10mo,两组的BCVA比较无统计学差异(P6mo=0.132, P10mo=0.47)；但在术后散光、高眼压、切口裂开等方面FS-PKP组的发生率明显低于传统PKP组,有统计学差异( P<0.05)。 　　结论：与传统的穿透性角膜移植相比,飞秒激光辅助的穿透性角膜移植术后早期的视力恢复快,角膜散光值和并发症的发生率显著降低,体现了这一新技术的临床优越性。
목적：평개응용비초격광보조천투성각막이식술( FS-PKP)적조기료효급안전성。 　　방법：회고성분석46례48안FS-PKP술병례。술전최가교정시력위2.35±1.01(표준대수시력표),각막병변루급전층,포괄원추각막、백반、외상성반흔등。채용비초격광제작불동직경화변연형상적전층각막식편여대응식상,진행각막이식술,술후치료여상규천투성각막이식술(전통PKP)상동。평개지표포괄술전급술후1,6,10mo적라안시력( UCVA)、최가교정시력( BCVA)、각막산광( CA)치、수술병발증。장동기완성적43례44안전통PKP병례작위대조조。량조수거채용통계연건SPSS 18.0성조설계적량양본균수비교화χ2검험。 　　결과：소유수술균순리완성,술후시력균유불동정도적제고；재여전통PKP적비교중,량충술식적술후UCVA재술후1mo시분별시3.48±0.43화2.97±1.14,유현저적통계학차이(P=0.009)；술후3mo시UCVA분별시3.86±0.25화3.74±0.73,술후6mo시분별시4.04±0.23화3.98±0.29,균무통계학차이( P=0.146, P=0.56)；FS-PKP조술후1 mo BCVA우우전통PKP수술조,차이유현저통계학의의(P=0.002),이술후6,10mo,량조적BCVA비교무통계학차이(P6mo=0.132, P10mo=0.47)；단재술후산광、고안압、절구렬개등방면FS-PKP조적발생솔명현저우전통PKP조,유통계학차이( P<0.05)。 　　결론：여전통적천투성각막이식상비,비초격광보조적천투성각막이식술후조기적시력회복쾌,각막산광치화병발증적발생솔현저강저,체현료저일신기술적림상우월성。
AlM: To evaluate the therapeutic effects and safety of femtosecond laser assisted penetrating keratoplasty ( FS-PKP) . METHODS: ln the retrospective case series study, 46 cases ( 48 eyes ) with FS- PKP holds were analyzed. Preoperative best corrected visual acuity ( BCVA) was 2. 35 ± 1.01 (with a standard logarithmic eye chart). Opacities were all from epithelium to endothelium, including keratoconus, keratolukoma and corneal scarring etc. The full-thickness corneal donor-recipient grafts in different diameter and incision kerfangle were made by femtosecond laser in keratoplasty. The patients were treated according to the conventional penetrating keratoplasty after surgery. Evaluation indexes included preoperative and postoperative 1, 6, 10mo uncorrected visual acuity (UCVA), BCVA, corneal astigmatism (CA) and surgical complications. Forty-three cases (44 eyes) with traditional PKP were as control group. The data of two groups were analyzed by mean comparison of two groups and Chi-square test in SPSS 18. 0. RESULTS: All the operations were completed successfully, postoperative visual acuity of all patients had different degrees of increase. Comparison with the postoperative UCVA of traditional PKP surgery, UCVA was 3. 48 ± 0. 43 and 2. 97 ± 1. 14 at 1mo after operation, respectively, with statistically significant difference ( P=0. 009). The UCVA was 3. 86±0. 25 and 3. 74±0. 73 at 3mo after operation, respectively; the UCVA was 4. 04 ± 0. 23 and 3. 98 ± 0. 29 at 6mo after operation, respectively, with no statistically significant difference (P=0. 146, P=0. 56). ln FS-PKP group, BCVA was better than traditional PKP surgery group, with statistically significant difference ( P=0. 002 ). While there had no statistically significant difference between two groups of BCVA at 6, 10mo after operation (P6mo =0. 132, P10mo =0. 47). The incidence of complication of FS-PKP surgery, such as postoperative astigmatism, postoperative intraocular pressure and postoperative incision dehiscence were significantly lower than the one of traditional PKP surgery(P<0. 05). CONCLUSlON:Compared with traditional penetrating keratoplasty, FS-PKP provides significantly faster visual recovery in the early postoperative period, and induces significantly less corneal astigmatism and lower incidence of complication. lt reflected the clinical superiority of this new technology .