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首页> 美国卫生研究院文献>Journal of Zhejiang University. Science. B >Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty
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Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty

机译：全床深前板层角膜移植术后角膜厚度分布和根尖位置对术后屈光状态的影响

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摘要

Objective: To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty (FBDALK). Methods: This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior (S-I) and nasal-temporal (N-T) corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center (S-I2 mm, S-I4 mm, S-I6 mm, S-I8 mm, N-T2 mm, N-T4 mm, N-T6 mm, and N-T8 mm), the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex (TA3 mm), the astigmatic vector values J 0 and J 45, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters (HOA3 mm and HOA6 mm). Statistical analysis was performed by SPSS 15.0. Results: A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was (28±7) months. The mean UCVA was 0.45±0.23 (logMAR) (MAR: minimum angle of resolution) and the mean BSCVA was 0.19±0.15 (logMAR), which were all significantly positively correlated with postoperative TA3 mm and HOA3 mm. The mean S-I corneal thickness differences were (44.62±37.74) μm, and the mean N-T was (38.57±32.29) μm. S-I2 mm was significantly positively correlated with J 0 (r=0.31), J 45 (r=0.42), HOA3 mm (r=0.37), and HOA6 mm (r=0.48). S-I4 mm and S-I8 mm were significantly positively correlated with HOA3 mm (r=0.30, r=0.40) and HOA6 mm (r=0.46, r=0.35). The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J 45 (r=0.29). Conclusions: In patients with advanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.
机译：目的：探讨全床深前板层角膜成形术（FBDALK）后角膜厚度分布和根尖位置对术后屈光状态的影响。方法：这是对我院2011年至2014年间诊断为晚期圆锥角膜的患者的回顾性分析。在所有患者中，圆锥体的底部在6毫米范围内均未超过中央角膜。 FBDALK由同一位外科医生执行。所有患者均已完全切除角膜缝线，并且随访记录完整。排除移植床错位或并发白内障或青光眼的患者。术后两年记录未矫正视力（UCVA），最佳眼镜矫正视力（BSCVA）和Pentacam检查数据。记录的数据包括以角膜顶点为中心的2mm，4mm，6mm和8mm直径的同心圆的上下（SI）和鼻颞（NT）角膜厚度差（S-I2 mm，S-I4毫米，S-I6毫米，S-I8毫米，N-T2毫米，N-T4毫米，N-T6毫米和N-T8毫米），角膜瞳孔之间的线性，X轴和Y轴距离中心和角膜顶点，距角膜顶点3毫米直径区域（TA3毫米）的总角膜散光，像散矢量值J 0和J 45以及3和6毫米瞳孔直径的角膜总高阶像差（HOA3毫米和HOA6毫米）。通过SPSS 15.0进行统计分析。结果：46名患者中的47只眼睛符合标准，被纳入本研究。平均随访时间为（28±7）个月。平均UCVA为0.45±0.23（logMAR）（MAR：最小分辨角），平均BSCVA为0.19±0.15（logMAR），均与术后TA3 mm和HOA3 mm呈显着正相关。平均S-1角膜厚度差为（44.62±37.74）μm，平均N-T为（38.57±32.29）μm。 S-I2 mm与J 0 （r = 0.31），J 45 （r = 0.42），HOA 3 mm （ r = 0.37）和HOA 6 mm （r = 0.48）。 SI 4 mm 和SI 8 mm 与HOA 3 mm 和HOA 呈显着正相关（r = 0.30，r = 0.40） 6毫米（r = 0.46，r = 0.35）。角膜瞳孔中心与角膜顶点之间的X轴距离与J 45 （ r = 0.29）呈显着正相关。结论：FBDALK术后晚期圆锥角膜患者，角膜瞳孔区域厚度分布不均以及角膜顶点和瞳孔中心错位可能导致明显的规则和不规则散光，影响术后视力。

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