Relaxing Incisions Combined With Adjustment Sutures for Post-Deep Anterior Lamellar Keratoplasty Astigmatism in Keratoconus
Relaxing Incisions Combined With Adjustment Sutures for Post-Deep Anterior Lamellar Keratoplasty Astigmatism in Keratoconus
复制标题
DOI：
10.1097/ico.0b013e3181a3c400
复制
发表时间：
2009-12
期刊：
影响因子：
2.8
通讯作者：
M. Javadi;S. Feizi;Firooz Mirbabaee;A. Rastegarpour
中科院分区：
文献类型：
--
作者：
M. Javadi;S. Feizi;Firooz Mirbabaee;A. Rastegarpour
目的：寻找一种有效、可靠的方法来矫正圆锥角膜患者深前板层角膜移植术（DALK）后的散光。患者和方法：该介入病例系列包括 14 名圆锥角膜患者（12 名男性）的 14 只眼睛，他们因无法忍受的 DALK 后散光而接受移植屈光手术 (GRS)。最初 5 例病例的 GRS 技术仅包括在移植物-宿主界面的陡峭子午线处放松切口直至后弹力层。其余的，在陡峭经线处的松弛切口同时进行缝合，并在术后几天开始选择性拆线来控制松弛切口的效果。主要结果是使用减法和矢量分析方法的未矫正和矫正视力以及屈光和角膜散光的变化。结果：患者平均年龄为 29.36 ± 6.2 岁。从完全拆线到 GRS 的平均时间间隔和随访期分别为 4.5 ± 2.0 个月和 12.0 ± 7.4 个月。术前平均最佳矫正视力为0.29±0.1，术后最小分辨角对数增加至0.22±0.1（P = 0.007）。通过减法和矢量分析方法测量，平均角膜散光分别减少了 3.8 和 5.5 屈光度。 5只只进行松弛切口的患者中有4只最初因过度矫正而需要缝合切口，而初步结果显示9名同时进行松弛切口和缝合的患者均不需要进一步干预。结论：放松切口，在陡峭的子午线处缝合，然后选择性拆线，可以有效且可预测地减少圆锥角膜患者的 DALK 后散光。
Purpose: To find an effective and reliable method to correct astigmatism after deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. Patients and Methods: This interventional case series included 14 eyes of 14 patients with keratoconus (12 males) undergoing graft refractive surgery (GRS) for intolerable post-DALK astigmatism. The technique of GRS for the 5 initial cases consisted of only relaxing incisions at the steep meridian in the graft-host interface down to Descemet membrane. For the rest, the relaxing incisions at the steep meridian were accompanied by simultaneous suturing and the effect of the relaxing incisions was controlled through selective suture removal starting a few days after the operation. The main outcomes were uncorrected and corrected visual acuity and change in refractive and keratometric astigmatism using subtraction and vector analysis methods. Results: Mean patient age was 29.36 ± 6.2 years. Mean time interval from complete suture removal to GRS and follow-up period were 4.5 ± 2.0 months and 12.0 ± 7.4 months, respectively. Mean preoperative best-corrected visual acuity was 0.29 ± 0.1, increasing to 0.22 ± 0.1 logarithm of minimum angle of resolution after the operation (P = 0.007). Average keratometric astigmatism was reduced by 3.8 and 5.5 diopters measured with subtraction and vector analysis methods, respectively. Four of 5 eyes that had only relaxing incisions initially required suturing of the incisions because of overcorrection, whereas preliminary results showed none of the 9 patients undergoing simultaneous relaxing incisions and suturing required further intervention. Conclusion: Relaxing incisions and suturing at the steep meridian followed by selective suture removal can effectively and predictably reduce post-DALK astigmatism in patients with keratoconus.