Clinical Evaluation of Electrolysis for Reis-Bucklers Corneal Dystrophies and In Vivo Histological Analysis Using Anterior Segment Optical Coherence Tomography
Clinical Evaluation of Electrolysis for Reis-Bucklers Corneal Dystrophies and In Vivo Histological Analysis Using Anterior Segment Optical Coherence Tomography
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电解治疗 Reis-Bucklers 角膜营养不良的临床评价和使用眼前节光学相干断层扫描的体内组织学分析
DOI：
10.1097/ico.0000000000002541
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发表时间：
2020
期刊：
影响因子：
2.8
通讯作者：
Sugiyama Kazuhisa
中科院分区：
文献类型：
--
作者：
Nishino Tsubasa;Kobayashi Akira;Mori Natsuko;Yokogawa Hideaki;Sugiyama Kazuhisa
目的：报告角膜电解治疗 Reis-Bücklers 角膜营养不良 (RBCD) 的有效性和临床结果，并使用眼前段光学相干断层扫描 (AS-OCT) 提供体内组织学分析。 方法：来自 3 个家系的 7 例 RBCD 患者（2 名男性患者，5 名女性患者；平均年龄，50.0 岁）纳入本前瞻性研究。所有患者均因视力下降或视力模糊而接受角膜电解术。电解后1个月评估视力、屈光度和角膜厚度的变化并进行统计分析。对电解前后AS-OCT图像的变化进行定性和定量评估。结果：在10.7年的中位随访期间，共对7名患者进行了22次电解手术。术后平均视力显着提高，最小分辨角对数从 0.59 提高到 0.31（P= 0.013）。屈光度（从− 2.42 到− 2.12 D）和角膜厚度（从 570.8 到 577.6 μm）的变化并不显着（分别为 P= 0.77 和 P= 0.80）。在所有情况下，AS-OCT 图像的评估表明，鲍曼层中的带状病变在电解后反射性降低。带状病变的平均厚度从101.5μm下降到88.3μm（P=0.002）。结论：角膜电解是治疗RBCD引起的角膜混浊的良好选择。角膜电解可提高视力而不改变角膜厚度或屈光度。因此，多年来重复角膜电解可能是 RBCD 的首选长期治疗策略。此外，AS-OCT 适合评估这种治疗的有效性，并且可能在术后随访中有用。
Purpose:To report the effectiveness and clinical outcomes of corneal electrolysis for Reis-Bücklers corneal dystrophies (RBCDs) and provide in vivo histological analysis using anterior segment optical coherence tomography (AS-OCT).Methods:A total of 7 patients with RBCD (2 male patients, 5 female patients; mean age, 50.0 years) from 3 pedigrees were enrolled in this prospective study. All patients underwent corneal electrolysis for decreased visual acuity or blurred vision. Changes in visual acuity, refraction, and corneal thickness were evaluated 1 month after electrolysis and statistically analyzed. Changes observed in AS-OCT images before and after electrolysis were qualitatively and quantitatively assessed.Results:A total of 22 electrolysis procedures were performed on 7 patients during the median follow-up period of 10.7 years. Mean visual acuity significantly improved postoperatively, from 0.59 to 0.31 logarithm of the minimum angle of resolution (P= 0.013). Changes in refraction (from− 2.42 to− 2.12 D) and corneal thickness (from 570.8 to 577.6 μm) were not significant (P= 0.77 and P= 0.80, respectively). In all cases, assessment of AS-OCT images showed that the band lesion in Bowman's layer became less reflective after electrolysis. The mean thickness of the band lesion decreased from 101.5 to 88.3 μm (P= 0.002).Conclusions:Corneal electrolysis is an excellent treatment option for corneal opacities caused by RBCD. Corneal electrolysis improves visual acuity without changing corneal thickness or refraction. Therefore, repeat corneal electrolysis over the years might be a preferred long-term treatment strategy for RBCD. Moreover, AS-OCT is suitable for evaluating the effectiveness of this treatment and might be useful during postoperative follow-up.