In vivo corneal confocal microscopy comparison of intralase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis
In vivo corneal confocal microscopy comparison of intralase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis
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DOI：
10.1167/iovs.05-1207
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发表时间：
2006-07-01
影响因子：
4.4
通讯作者：
Baudouin, Christophe
中科院分区：
文献类型：
--
作者：
Sonigo, Bertrand;Iordanidou, Vasiliki;Baudouin, Christophe
目的.使用新一代Heidelberg Retina Tomograph II（HRT II）/罗斯托克角膜模块共焦显微镜，评估和比较IntraLase PulsionFS飞秒激光和机械微型角膜刀Hansatome在激光原位角膜磨镶术（LASIK）中诱导的角膜改变。在这项病例对照研究中，在IntraLase飞秒激光LASIK近视手术的随访中，使用HRT II检查了12例患者的24只眼。10例20眼行显微角膜刀Hansatome-LASIK手术。在两组中，患者在术后第7天和最后12个月接受首次随访检查。对角膜结构的形态学改变进行了评价，并对两种角膜瓣形成技术进行了比较。在第7天对两组的评估显示角膜细胞转化，最可能与界面下的细胞活化相关。IntraLase技术后的皮瓣边缘在显微镜下显示为包括上皮栓的清晰边缘。在第2个月时，观察到继发性纤维化，邻近仍然清晰的IntraLase皮瓣边缘。该反应随时间而减弱，在源自周围基质的伤口收缩附近留下纤维化瘢痕。机械角膜刀的角膜瓣边缘有一个不太清楚的纤维化瘢痕，没有上皮栓。这项研究揭示了飞秒激光和机械角膜刀获得的界面之间的形态相似性，可能是因为相同的准分子激光进行光消融。然而，IntraLase角膜瓣边缘的纤维化瘢痕比机械微型角膜刀诱导的瘢痕更严重。
PURPOSE. To assess and compare corneal modifications induced by IntraLase PulsionFS femtosecond laser and mechanical microkeratome Hansatome for laser in situ keratomileusis (LASIK) using the new-generation Heidelberg Retina Tomograph II (HRT II)/Rostock Cornea Module confocal microscope.METHODS. In this case-control study, 24 eyes of 12 patients were examined with the HRT II in the follow-up of IntraLase femtosecond laser for LASIK myopic surgery. Twenty eyes of 10 patients were also examined after microkeratome Hansatome-LASIK surgery. In both groups, the patients underwent the first follow-up examination on day 7 and the last 12 months after surgery. Morphologic modifications of corneal architecture were evaluated, and comparisons were made between the two flap-formation techniques.RESULTS. Evaluation of both groups on day 7 showed keratocyte transformation, most likely related to cellular activation beneath the interface. The flap margin after the IntraLase technique appeared microscopically as a clear-cut edge that included the epithelial plug. At month 2, secondary fibrosis, adjacent to the still well-defined IntraLase flap edge, was observed. This reaction diminished with time, leaving a fibrotic scar adjacent to a wound constriction originating from the surrounding stroma. The flap margin of the mechanical microkeratome had the appearance of a less clearly identified fibrotic scar with no epithelial plug.CONCLUSIONS. This study reveals morphologic similarities between the interfaces obtained by femtosecond laser and mechanical microkeratome, probably because the same excimer laser performed the photoablation. However, the IntraLase flap margin showed greater fibrotic scarring than that induced by the mechanical microkeratome.