目的:评估Reis-Bücklers角膜营养不良(RBCD)患者的光学相干断层扫描复发特征和临床结果。
方法:回顾性介入病例系列。
方法:17例RBCD患者(31只眼,从1996年到2022年,包括6只手术幼稚的眼睛和25只手术眼睛)接受了44次手术干预。PTK或PKP作为初始外科手术进行。当最佳眼镜矫正视力降低至少两行,浅表角膜不透明度增加时,确定了明显的复发。如果患者由于明显复发而无法忍受视力不佳,则考虑在角膜移植物上重复PTK或PTK(CG-PTK)。通过眼前段光学相干断层扫描评估中央角膜和上皮下沉积物的复发深度和厚度的年增加。
结果:平均随访时间为12.8±8.5年(范围,2.0-25.5年)。初始PTK组的平均logMAR最佳眼镜矫正视力从术前的1.24±0.48提高到术后的0.27±0.09(13只眼,P<0.001),PKP组的1.84±0.69至0.40±0.13(12只眼,P<0.001),重复PTK组从1.04±0.46到0.30±0.07(7眼12次,P<0.001),CG-PTK组从1.29±0.43到0.39±0.11(5眼7次,P=0.001)。中位显着复发时间为27个月(95%置信区间23.9-30.1),96个月(84.1-107.9),31个月(28.8-33.1),和24个月(19.8-28.2),分别(P<0.001)。位于上皮和前基质之间的表面沉积物的深度约为115μm(85-159μm)。最初的PTK后,上皮下沉积物的年增厚为14±2μm,PKP后7±3μm,重复PTK后14±3μm,CG-PTK后30±11μm,与未手术眼的4±2μm相比(P=0.002、0.515、0.002,<0.001)。角膜中央厚度增加15±2μm,7±2μm,15±3μm,四个手术组每年31±10μm,分别,与手术初治眼的5±2μm相比(P=0.001,0.469,0.001,<0.001)。
结论:对于RBCD的治疗,PTK后的视力优于PKP。上皮下沉积物的年度增厚可能近似于中央角膜厚度的增加。上皮下沉积物的表面分布使得重复进行PTK是可行的,甚至在同种异体角膜移植上,用于经常性RBCD。
OBJECTIVE: To evaluate the recurrence characteristics on optical coherence tomography and clinical outcomes after phototherapeutic keratectomy (PTK) or penetrating keratoplasty (PKP) in patients with Reis-Bücklers corneal dystrophy (RBCD).
METHODS: Retrospective interventional case series.
METHODS: Seventeen patients with RBCD (31 eyes, including 6 surgery-naïve eyes and 25 surgical eyes) received 44 surgical interventions from 1996 through 2022. PTK or PKP was performed as the initial surgical procedure. Significant recurrence was determined when best spectacle-corrected visual acuity decreased at least 2 lines with increased opacity in the superficial cornea. Repeated PTK or PTK on the corneal graft (CG-PTK) was considered if patients could not endure poor vision due to significant recurrence. Recurrence depth and annual increase in thickness of the central cornea and subepithelial deposits were assessed by anterior segment optical coherence tomography.
RESULTS: The mean follow-up time was 12.8 ± 8.5 years (range, 2.0-25.5 years). The mean logMAR best spectacle-corrected visual acuity improved from 1.24 ± 0.48 preoperatively to 0.27 ± 0.09 postoperatively in the initial PTK group (13 eyes, P < .001), from 1.84 ± 0.69 to 0.40 ± 0.13 in the PKP group (12 eyes, P < .001), from 1.04 ± 0.46 to 0.30 ± 0.07 in the repeated PTK group (12 times in 7 eyes, P < .001), and from 1.29 ± 0.43 to 0.39 ± 0.11 in the CG-PTK group (7 times in 5 eyes, P = .001). The median significant recurrence time was 27 months (95% confidence interval 23.9-30.1), 96 months (84.1-107.9), 31 months (28.8-33.1), and 24 months (19.8-28.2), respectively (P < .001). The depth of superficial deposits located between the epithelium and the anterior stroma was approximately 115 µm (85-159 µm). The annual thickening of subepithelial deposits was 14 ± 2 µm after initial PTK, 7 ± 3 µm after PKP, 14 ± 3 µm after repeated PTK, and 30 ± 11 µm after CG-PTK, compared to 4 ± 2 µm in surgery-naïve eyes (P = .002, .515, .002, <.001). The thickness of the central cornea increased by 15 ± 2 µm, 7 ± 2 µm, 15 ± 3 µm, and 31 ± 10 µm per year in the 4 surgery groups, respectively, compared to 5 ± 2 µm in surgery-naïve eyes (P = .001, .469, .001, <.001).
CONCLUSIONS: Better visual acuity can be achieved after PTK than PKP for treatment of RBCD. The annual thickening of subepithelial deposits may approximate an increase in central corneal thickness. The superficial distribution of subepithelial deposits makes it feasible to perform repeated PTK, even on the corneal allograft, for recurrent RBCD.