Mesh : Adult Bowman Membrane Corneal Stroma / surgery Corneal Surgery, Laser Corneal Topography Humans Hyperopia / surgery Refraction, Ocular

来  源:   DOI:10.3928/1081597X-20211215-01

Abstract:
OBJECTIVE: To evaluate the feasibility and report long-term outcomes with Bowman\'s membrane relaxation (BMR) for enhancing the residual refractive error following femtosecond intrastromal lenticule implantation (FILI).
METHODS: BMR was performed using a Hessburg-Barron trephine to create a circular incision into the Bowman\'s membrane and anterior corneal fibers up to the depth of approximately 120 to 130 µm. After enhancement, clinical outcomes were analyzed for a mean period of 36 months (range: 14 to 57 months).
RESULTS: Four eyes of 3 patients (mean age: 29 years) underwent enhancement with BMR for a significant residual refractive error of +2.25 diopters (D) spherical equivalent following FILI for high hyperopia (mean spherical equivalent: +7.00 D). After BMR, the residual refraction reduced to +0.31 D, resulting in improvement in uncorrected distance visual acuity from 0.55 to 0.33 logMAR. The mean front keratometry values increased from 46.20 to 49.30 D, and the mean back keratometry values increased from -5.90 to -6.30 D following BMR, the latter returning to the baseline (pre-FILI) value of -6.30 D. An increase in Q-value with a corresponding increase in higher order aberrations was observed. Corneal biomechanics indicated reduction of stiffness and other parameters after enhancement. No intraoperative or postoperative complications were noted.
CONCLUSIONS: BMR may be an effective technique for enhancement of residual hyperopia following tissue addition techniques such as FILI. BMR may reverse the posterior curvature changes, negating the steepening effect of the anterior cornea following tissue addition, potentially aiding in the enhancement. [J Refract Surg. 2022;38(2):134-141.].
摘要:
目的:评估Bowman膜松弛(BMR)增强飞秒基质内透镜植入(FILI)后残余屈光不正的可行性并报告长期结果。
方法:使用Hessburg-Barron环钻在Bowman膜和角膜前纤维中形成圆形切口,深度约为120至130µm。增强后,我们分析了平均36个月(范围:14~57个月)的临床结局.
结果:3名患者(平均年龄:29岁)的四只眼睛在高度远视FILI(平均等效球面:7.00D)后接受BMR增强治疗,导致明显的残余屈光误差为2.25屈光度(D)等效球面。BMR之后,残余折射减少到+0.31D,导致未矫正的远距视力从0.55提高到0.33logMAR。平均前角膜曲率测量值从46.20D增加到49.30D,BMR后,平均背部角膜曲率测量值从-5.90D增加到-6.30D,后者恢复到-6.30D的基线(FILI前)值。观察到Q值增加,高阶像差相应增加。角膜生物力学表明增强后刚度和其他参数降低。术中或术后无并发症发生。
结论:BMR可能是增强FILI等组织添加技术后的残余远视的有效技术。BMR可以逆转后曲率的变化,消除组织添加后角膜前部的陡峭化效应,可能有助于增强。[JRefractSurg.2022年;38(2):134–141。].
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