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首页> 外文期刊>Journal of refractive surgery >Refractive and topographic errors in topography-guided ablation produced by epithelial compensation predicted by 3D artemis VHF digital ultrasound stromal and epithelial thickness mapping
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Refractive and topographic errors in topography-guided ablation produced by epithelial compensation predicted by 3D artemis VHF digital ultrasound stromal and epithelial thickness mapping

机译：由3D artemis VHF数字超声基质和上皮厚度映射预测的上皮补偿产生的地形引导性消融中的屈光和地形误差

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PURPOSE: To describe and quantify the errors inherent to topography-guided ablation of irregular corneas due to natural epithelial thickness compensatory remodeling. METHODS: Artemis very high-frequency (VHF) digital ultrasound scanning (ArcScan Inc) was performed on a cornea that had undergone radial keratotomy with inferior and superior trapezoidal keratotomies, resulting 27 years later in high irregular astigmatism (+6.50 -8.00 x 101) and severe loss of corrected distance visual acuity (CDVA) to 20/50. The epithelial thickness profile was highly irregular, masking a significant proportion of the true stromal irregularity from front corneal surface topography, which would have resulted in significant inaccuracies had a topography-guided ablation been performed. The stromal ablation pattern of a transepithelial phototherapeutic keratectomy (PTK) ablation was modeled, which appeared logically to reduce the areas of abnormal stromal surface elevation and resembled a hyperopic astigmatic ablation of approximately 3.50 diopters of cylinder. Artemis-assisted transepithelial PTK was performed to target the stromal irregularity masked by epithelium. RESULTS: Artemis-assisted transepithelial PTK induced a refractive change similar to that predicted (+2.24 -3.97 x 120), demonstrating the refractive shift produced by the epithelium. The epithelial thickness profile became relatively regular and CDVA returned to 20/20 -2. Two topography wavefront-guided ablations were performed to correct the remaining topographic irregularity and refractive error, resulting in a near plano refraction, significantly lower higher order aberrations, and CDVA of 20/20 +2. CONCLUSIONS: A knowledge of stromal surface shape and power shift produced by epithelial thickness profile alterations after corneal surgery has the potential of improving the efficacy and safety of custom corneal ablation.
机译：目的：描述和量化由于自然上皮厚度补偿性重塑导致的不规则角膜地形图引导消融所固有的误差。方法：Artemis超高频（VHF）数字超声扫描（ArcScan Inc）对已经进行了放射状角膜切开术和下梯形和上梯形角膜切开术的角膜进行了扫描，导致27年后出现高度不规则散光（+6.50 -8.00 x 101）矫正远视力（CDVA）严重丧失至20/50。上皮厚度分布高度不规则，从前角膜表面形貌掩盖了真实比例的真实基质不规则，如果进行了形貌引导的消融，则将导致严重的误差。对经上皮光疗性角膜切除术（PTK）消融的基质消融模式进行了建模，这在逻辑上减少了异常基质表面抬高的区域，并类似于约3.50屈光度的远视散光消融。进行了Artemis辅助的上皮PTK，以靶向上皮掩盖的基质不规则。结果：Artemis辅助的上皮PTK引起的屈光改变与预测的相似（+2.24 -3.97 x 120），证明了上皮产生的屈光偏移。上皮厚度分布变得相对规则，并且CDVA回到20/20 -2。进行了两次地形波前引导消融，以纠正剩余的地形不规则性和屈光不正，从而导致近平面折射，明显更低的高阶像差和20/20 +2的CDVA。结论：了解角膜手术后上皮厚度分布改变所产生的基质表面形状和功率变化具有改善常规角膜消融疗效和安全性的潜力。

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