目的:分析Bowman层(BL)嵌体移植术治疗渐进性,晚期圆锥角膜.
方法:前瞻性,介入病例系列。
方法:21只眼行BL嵌体移植。去除上皮后,单或双BL移植物被“拉伸”到角膜表面,允许干燥,并放置柔软的绷带透镜,直到移植物再次上皮化。最佳眼镜和/或最佳隐形眼镜矫正视力(BSCVA/BCLVA),角膜断层扫描,分析了全组和两个亚组的术后并发症发生率[第1组:术前最大角膜曲率(Kmax)<69D(n=7),第2组:术前Kmax≥69D(n=14)]。随访6~36个月,平均21±11个月。
结果:所有21例手术均顺利。总的来说,Kmax从术前的76±12D变化到术后6-36个月的72±9D(P=0.015)。第2组Kmax下降了6D(P=0.002),但第1组没有变化。第1组的平均BSCVA保持稳定,第2组的LogMAR从术前的0.8±0.4提高到术后的0.4±0.2(P=0.032);BCLVA保持稳定(P>0.05)。在术后的头几周内,两只眼睛在意外摘除绷带晶状体后需要重新定位BL移植物,四只眼睛因上皮不完全再形成而接受了BL再移植.创伤性角膜糜烂术后12个月,一只眼睛接受了BL再移植。在最后一次可用的随访中,所有眼睛都显示出完全重新上皮化的移植物。
结论:BL覆盖移植是一种完全眼外移植,微创外科技术,在晚期进行性圆锥角膜的眼睛中提供高达-6D的角膜扁平化,允许持续(巩膜)隐形眼镜佩戴,因此保留BCLVA。
To analyze the clinical outcomes after Bowman layer (BL) onlay grafting for the treatment of progressive, advanced keratoconus.
Prospective, interventional case series.
Twenty-one eyes underwent BL onlay grafting. After removing the epithelium, a single or double BL graft was \"stretched\" onto the corneal surface, allowed to dry-in, and a soft bandage lens was placed until the graft was re-epithelialized. Best spectacle- and/or best contact lens-corrected visual acuity (BSCVA/BCLVA), corneal tomography, and postoperative complication rates were analyzed for the total group and 2 subgroups (group 1: preoperative maximum keratometry [Kmax] <69 diopters [D; n = 7); group 2: preoperative Kmax ≥69 D [n = 14]). Follow-up ranged from 6 to 36 months (mean 21 ± 11 months).
All 21 surgeries were uneventful. Overall, Kmax changed from 76 ± 12 D preoperatively to 72 ± 9 D at 6 to 36 months postoperatively (P = .015). Kmax decreased by 6 D in group 2 (P = .002) but did not change in group 1. Average BSCVA remained stable for group 1 and improved from preoperatively 0.8 ± 0.4 to 0.4 ± 0.2 logarithm of the minimum angle of resolution postoperatively in group 2 (P = .032); BCLVA remained stable (P > .05). Within the first postoperative weeks, 2 eyes required BL graft repositioning after inadvertent bandage lens removal and 4 eyes underwent BL retransplantation for incomplete re-epithelialization. One eye underwent BL regrafting 12 months postoperatively after traumatic corneal erosion. All eyes showed a completely re-epithelialized graft at the last available follow-up.
BL onlay grafting is a completely extraocular, minimally invasive surgical technique, providing up to -6 D of corneal flattening in eyes with advanced progressive keratoconus, allowing for continued (scleral) contact lens wear and therefore preserving the BCLVA.