飞秒激光辅助的两种深板层角膜移植治疗圆锥角膜疗效比较

目的 比较飞秒激光辅助的切除75％以上基质层的深板层角膜移植(deep anterior lamellar keratoplasty,DALK)(preDescemetic DALK)和飞秒激光联合Anwar大气泡技术切除全部基质层DALK(Descemetic DALK)治疗圆锥角膜的临床效果.方法 17例20眼圆锥角膜患者,9例10眼行飞秒激光辅助的pre-Descemetic DALK,8例10眼行飞秒激光辅助的Anwar大气泡Descemetic DALK,术后随访1 a,比较2组术后最佳矫正视力(best-corrected visual acuity,BCVA)、屈光状态、角膜曲率、内皮细胞丢失率及中央角膜厚度.结果 所有手术顺利完成.术后1 a,pre-Descemetic DALK组BCVA为0.52 ±0.24,Descemetic DALK组BCVA为0.49±0.19,差异无统计学意义(P=0.758);pre-Descemetic DALK组近视度数为(-9.43±7.44)D,地形图测量角膜散光度数为(3.73 ±2.58)D,Descemetic DALK组近视度数为(-1.03±1.13)D,角膜散光度数为(3.21±3.10)D,两组间近视度差异显著(P =0.002),散光度数差异无统计学意义(P=0.684);角膜曲率pre-Descemetic DALK组为(44.30±4.18)D,Descemetic DALK组为(42.21±2.82)D,差异无统计学意义(P=0.208),内皮细胞丢失率分别为4.6％和6.4％,差异无统计学意义(P=0.258).术后中央角膜厚度pre-Descemetic DALK组为(483.40±53.70) μm,Descemetic DALK组为(471.50±41.68)μm,差异无统计学意义(P=0.587).结论 飞秒激光辅助的大气泡Descemetic DALK术后屈光状态显示近视度数小,可作为治疗中晚期圆锥角膜的更好术式.