Excimer laser smoothing of endothelial keratoplasty grafts.
Excimer laser smoothing of endothelial keratoplasty grafts.
复制标题
准分子激光平滑内皮角膜移植术。
DOI：
10.1097/ico.0b013e31822444a7
复制
发表时间：
2012
期刊：
影响因子：
2.8
通讯作者：
Huang,David
中科院分区：
文献类型：
--
作者：
Cleary,Catherine;Liu,Ying;Tang,Maolong;Li,Yan;Stoeger,Christopher;Huang,David
目的应用准分子激光光滑术对Descemet剥离自动内皮角膜移植(DSAEK)内皮移植物进行整形，并评价其对供体内皮的影响。采用准分子激光远视消融，改善光学区内移植物厚度的均匀性。傅立叶域光学相干断层扫描用于测量内皮移植物厚度、计划消融和评估供体轮廓。活体染料染色评价内皮细胞损伤。由蒙面观察者对基质表面的扫描电子显微镜图像进行5分分级，以评估表面粗糙度。活体染料染色未见内皮细胞损伤。经激光光整的微角膜切削面(平均分级=2.0 4)比非光滑的微角膜切削面(平均分级=4.0 7；P<0.0 1)、干式激光切削组(平均分级=3.6 3；P<0.0 1)和人工解剖的界面(平均分级=4.75；P<0.0001)更光滑。剥离后弹力膜形成的基质层(平均等级为1.64)与微角膜刀切割后激光光整(平均等级=2.04；P=0.14)的表面相比，差异无统计学意义。1例移植物行准分子激光联合周边远视消融术。消融前中心-外周厚度差为15μm，消融后为4μm。结论激光光滑化可以在不损伤供体内皮细胞的前提下，改善移植物的外形和光滑度。使用准分子激光重塑供者是否能改善DSAEK术后的视力，还需要临床试验来确定。
PurposeTo use excimer laser smoothing passes to reshape Descemet-stripping automated endothelial keratoplasty (DSAEK) endothelial grafts and to evaluate the effect on the donor endothelium.MethodsThe stromal surface of microkeratome-cut DSAEK grafts was smoothed using excimer laser smoothing passes with masking fluid. Excimer laser hyperopic ablation was used to improve the uniformity of graft thickness within the optical zone. Fourier-domain optical coherence tomography was used to measure endothelial graft pachymetry, plan ablations, and evaluate donor contour. Vital dye staining was performed to assess endothelial cell damage. Scanning electron microscopy images of stromal surfaces were graded on a 5-point scale by masked observers to evaluate surface roughness.ResultsFour grafts underwent excimer laser smoothing. Vital dye staining showed no endothelial damage. Microkeratome-cut surfaces treated with laser smoothing (mean grade= 2.04) were smoother than nonsmoothed microkeratome-cut surfaces (mean grade= 4.07; P< 0.01), surfaces that underwent dry laser ablation (mean grade= 3.63; P< 0.01) and manually dissected interfaces (mean grade= 4.75; P< 0.0001). No difference was observed between stromal beds created by peeling Descemet membrane (mean grade= 1.64) compared with surfaces produced by microkeratome cutting followed by laser smoothing (mean grade= 2.04; P= 0.14). One graft underwent combined excimer smoothing and peripheral hyperopic ablation. The center–periphery thickness difference was 15 μm before ablation and 4 μm afterward.ConclusionsLaser smoothing passes can be used to improve the contour and smoothness of DSAEK grafts without damaging donor endothelial cells. Clinical trials are needed to determine whether reshaping donors using excimer laser can deliver improved visual outcomes after DSAEK.