全飞秒角膜基质透镜在远视屈光矫正手术中的应用

doi:10.6040/j.issn.1673-3770.0.2021.328

摘要/Abstract

摘要： 随着飞秒激光小切口角膜基质透镜取出术(SMILE)的广泛开展,如何合理应用术中取出的角膜基质透镜材料逐渐成为近年来的研究热点之一。由于角膜基质透镜具有低免疫源性、低病原感染风险及高组织相容性等优点,因而可作为角膜修补、角膜移植及屈光矫正的良好材料。近年来,角膜基质透镜被初步应用于远视的矫正手术之中,相比于传统的“减法”手术具有独特优点,包括减少对自身角膜组织的切削、更强的角膜生物力学特征及更广泛的适应人群,尤其适用于存在角膜过薄、超高度远视等减法手术难以处理的患者。就近年来全飞秒角膜基质透镜在远视矫正中的手术效果及存在的问题展开讨论。

关键词: 角膜基质透镜, 远视矫正, 屈光不正, 角膜屈光手术

Abstract: With the development and extensive application of small incision lenticule extraction(SMILE)surgeries, the possible use of extracted corneal stromal lenticules from patients has recently received increasing attention. Due to their low immunogenicity, low risk of cross-transmission, and high tissue compatibility, corneal stromal lenticules are good materials for corneal repair and transplantation, and refractive power correction. Recently, corneal stromal lenticules have been primarily applied for hyperopia correction. Compared to conventional subtraction surgeries, implantation of corneal stromal lenticules to correct hyperopia has some unique advantages, including reduced corneal tissue ablation, stronger corneal biomechanical properties, and broader indications, making it suitable specifically for hyperopic patients with thin corneas or extremely high hyperopia who are not indicated for subtraction surgeries. This review introduces recent applications of corneal stromal lenticule implantation for hyperopia correction, and discusses the remaining research problems of this surgical approach.

Key words: Corneal stromal lenticule, Hyperopia correction, Ametropia, Corneal refractive surgery

中图分类号:

R779.63

王力翔,李莹,邓应平. 全飞秒角膜基质透镜在远视屈光矫正手术中的应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 7-12.

WANG Lixiang,LI Ying, DENG Yingping. The application of corneal stromal lenticules extracted from small incision lenticule extraction surgery for hyperopia correction[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(6): 7-12.

参考文献

[1] Kim TI, Alió del Barrio JL, Wilkins M, et al. Refractive surgery[J]. Lancet, 2019, 393(10185): 2085-2098. doi:10.1016/S0140-6736(18)33209-4.
[2] Wang Y, Ma J. Future developments in SMILE: higher degree of myopia and hyperopia[J]. Asia Pac J Ophthalmol(Phila), 2019, 8(5): 412-416. doi:10.1097/01.apo.0000580128.27272.bb.
[3] Moshirfar M, Bruner CD, Skanchy DF, et al. Hyperopic small-incision lenticule extraction[J]. Curr Opin Ophthalmol, 2019, 30(4): 229-235. doi:10.1097/icu.0000000000000580.
[4] Pradhan KR, Reinstein DZ, Carp GI, et al. Small incision lenticule extraction(SMILE)for hyperopia: 12-month refractive and visual outcomes[J]. J Refract Surg Thorofare N J, 2019, 35(7): 442-450. doi:10.3928/1081597X-20190529-01.
[5] Randleman JB, Banning CS, Stulting RD. Corneal ectasia after hyperopic LASIK[J]. J Refract Surg, 2007, 23(1): 98-99. doi:10.3928/1081-597x-20070101-17.
[6] Melki SA, Azar DT. LASIK complications: etiology, management, and prevention[J]. Surv Ophthalmol, 2001, 46(2): 95-116. doi:10.1016/s0039-6257(01)00254-5.
[7] Lee BS. Accuracy and stability of hyperopic treatments[J]. Curr Opin Ophthalmol, 2014, 25(4): 281-285. doi:10.1097/icu.0000000000000066.
[8] El-Helw MA, Emarah AM. Predictability and stability of refraction with increasing optical zone diameter in hyperopic LASIK[J]. Clin Ophthalmol, 2010, 4: 455-458. doi:10.2147/opth.s11007.
[9] Biscevic A, Pidro A, Pjano MA, et al. Lasik as a solution for high hypermetropia[J]. Med Arch, 2019, 73(3): 191-194. doi:10.5455/medarh.2019.73.191-194.
[10] Song YJ, Kim S, Yoon GJ. Case series: Use of stromal lenticule as patch graft[J]. Am J Ophthalmol Case Rep, 2018, 12: 79-82. doi:10.1016/j.ajoc.2018.09.009.
[11] Liu YC, Teo EPW, Ang HP, et al. Biological corneal inlay for presbyopia derived from small incision lenticule extraction(SMILE)[J]. Sci Rep, 2018, 8(1): 1831. doi:10.1038/s41598-018-20267-7.
[12] Shang YF, Li Y, Wang ZQ, et al. Risk evaluation of human corneal stromal lenticules from SMILE for reuse[J]. J Refract Surg Thorofare N J, 2021, 37(1): 32-40. doi:10.3928/1081597X-20201030-03.
[13] Mohamed-Noriega K, Toh KP, Poh R, et al. Cornea lenticule viability and structural integrity after refractive lenticule extraction(ReLEx)and cryopreservation[J]. Mol Vis, 2011, 17: 3437-3449.
[14] Yam GH, Yusoff NZ, Goh TW, et al. Decellularization of human stromal refractive lenticules for corneal tissue engineering[J]. Sci Rep, 2016, 6: 26339. doi:10.1038/srep26339.
[15] Damgaard IB, Riau AK, Liu YC, et al. Reshaping and customization of SMILE-derived biological lenticules for intrastromal implantation[J]. Invest Ophthalmol Vis Sci, 2018, 59(6): 2555-2563. doi:10.1167/iovs.17-23427.
[16] Tanriverdi C, Ozpinar A, Haciagaoglu S, et al. Sterile excimer laser shaped allograft corneal inlay for hyperopia: one-year clinical results in 28 eyes[J]. Curr Eye Res, 2021, 46(5): 630-637. doi:10.1080/02713683.2021.1884728.
[17] 周跃华, 张晶, 李颖, 等. 自体角膜基质透镜植入术矫治远视的临床应用[J]. 中华实验眼科杂志, 2013, 31(2): 156-159. doi:10.3760/cma.j.issn.2095-0160.2013.02.012. ZHOU Yuehua, ZHANG Jing, LI Ying, et al. Application of autologous corneal len inlays in correction of hyperopia[J]. Chin J Exp Ophthalmol, 2013, 31(2): 156-159. doi:10.3760/cma.j.issn.2095-0160.2013.02.012.
[18] Sun L, Yao P, Li M, et al. The safety and predictability of implanting autologous lenticule obtained by SMILE for hyperopia[J]. J Refract Surg, 2015, 31(6): 374-379. doi:10.3928/1081597x-20150521-03.
[19] Zhao J, Zhao F, Huang JR, et al. Two-year outcome of a patient treated with phototherapeutic keratectomy and autologous SMILE lenticule transplantation for flap-related complications following LASIK[J]. J Refract Surg, 2018, 34(4): 281-285. doi:10.3928/1081597x-20180130-01.
[20] Li M, Li M, Sun L, et al. In vivo confocal microscopic investigation of the cornea after autologous implantation of lenticules obtained through small incision lenticule extraction for treatment of hyperopia[J]. Clin Exp Optom, 2018, 101(1): 38-45. doi:10.1111/cxo.12595.
[21] Liu M, Zhang T, Zhou Y, et al. Corneal regeneration after femtosecond laser small-incision lenticule extraction: a prospective study[J]. Graefes Arch Clin Exp Ophthalmol, 2015, 253(7): 1035-1042. doi:10.1007/s00417-015-2971-9.
[22] 王力翔, 李莹. SMILE、FS-LASIK及T-PRK术后角膜神经纤维的恢复情况及其与主观视觉质量的相关性研究[J]. 中华眼科杂志, 2018, 54(10): 737-743. doi:10.3760/cma.j.issn.0412-4081.2018.10.004. WANG Lixiang, LI Ying. Regeneration of corneal nerve after SMILE, FS-LASIK and T-PRK surgery and study its relationship with subjective visual quality[J]. Chin J Ophthalmol, 2018, 54(10): 737-743. doi:10.3760/cma.j.issn.0412-4081.2018.10.004.
[23] Carpel EF, Santilli C, Maltry A. Long-term viability of allogenic donor stroma[J]. Indian J Ophthalmol, 2020, 68(12): 3057-3059. doi:10.4103/ijo.ijo_1008_20.
[24] Moshirfar M, Shah TJ, Masud M, et al. A modified small-incision lenticule intrastromal keratoplasty(sLIKE)for the correction of high hyperopia: a description of a new surgical technique and comparison to lenticule intrastromal keratoplasty(LIKE)[J]. Med Hypothesis Discov Innov Ophthalmol, 2018, 7(2): 48-56.
[25] Wu JW, Xiong L, Wang Z, et al. Correction of moderate to high hyperopia with implantation of an allogeneic refractive lenticule[J]. J Refract Surg Thorofare N J, 2020, 36(11): 772-779. doi:10.3928/1081597X-20200826-01.
[26] Seiler T, Krishna P, Bhavatharini M, et al. Lenticule intrastromal keratoplasty(LIKE)for hyperopia correction[C]. Lisbon: European Society of Cataract and Refractive Surgeons, 2017.
[27] 周跃华, 张晶, 郑燕, 等. 同种异体角膜基质透镜植入术矫治远视的早期临床疗效[J]. 中华眼科杂志, 2015, 51(9): 683-688. doi: 10.3760/cma.j.issn.0412-4081.2015.09.009. ZHOU Yuehua,ZHANG Jing,ZHENG Yan,et al. The early clinical efficacy of allogeneic corneal lens inlays in correction of hyperopia[J]. Chinese Journal of Ophthalmology, 2015, 51(9): 683-688. doi: 10.3760/cma.j.issn.0412-4081.2015.09.009.
[28] 张晶, 翟长斌, 郑燕,等. 全飞秒激光角膜基质透镜植入术矫治中高度远视的一年随访研究[J]. 中华实验眼科杂志, 2018, 36(5): 355-359. doi: 10.3760/cma.j.issn.2095-0160.2018.05.007. ZHANG Jing,ZHAI Changbin,ZHENG Yan,et al.Allogeneic corneal small incision intrastromal lenticule inlays for moderate and high hyperopia: one year follow-up[J]. Chinese Journal of Experimental Ophthalmology,2018, 36(5): 355-359. doi: 10.3760/cma.j.issn.2095-0160.2018.05.007.
[29] 李美燕, 刘盛涛, 周行涛, 等. 飞秒激光同种异体角膜基质透镜移植矫正中高度远视2年临床疗效研究[J]. 中国激光医学杂志, 2021,30(1): 52.
[30] Lazaridis A, Reinstein DZ, Archer TJ, et al. Refractive lenticule transplantation for correction of iatrogenic hyperopia and high astigmatism after LASIK[J]. J Refract Surg, 2016, 32(11): 780-786. doi:10.3928/1081597x-20160726-01.
[31] 凌玲, 陈敬旺, 姚玲, 等. 角膜基质透镜散光标记器在角膜基质透镜植入术矫正远视及散光中的应用[J]. 眼科新进展, 2021,41(9): 861-864. doi:10.13389/j.cnki.rao.2021.0180. LING Ling, CHEN Jingwang, YAO Ling, et al. Application of corneal stromal lens astigmatism marker in corneal stroma lens implantation for correcting hyperopia and astigmatism[J]. Recent Adv Ophthalmol, 2021,41(9): 861-864. doi:10.13389/j.cnki.rao.2021.0180.
[32] Zhao J, Liu R, Shen Y, et al. Two-year observation of morphologic and histopathologic changes in the monkey cornea following small incision allogenic lenticule implantation[J]. Exp Eye Res, 2020, 192: 107935. doi:10.1016/j.exer.2020.107935.
[33] Pradhan KR, Reinstein DZ, Carp GI, et al. Femtosecond laser-assisted keyhole endokeratophakia: correction of hyperopia by implantation of an allogeneic lenticule obtained by SMILE from a myopic donor[J]. J Refract Surg, 2013, 29(11): 777-782. doi:10.3928/1081597x-20131021-07.
[34] Damgaard IB, Ivarsen A, Hjortdal J. Biological lenticule implantation for correction of hyperopia: an ex vivo study in human corneas[J]. J Refract Surg, 2018, 34(4): 245-252. doi:10.3928/1081597x-20180206-01.
[35] Williams GP, Wu B, Liu YC, et al. Hyperopic refractive correction by LASIK, SMILE or lenticule reimplantation in a non-human primate model[J]. PLoS One, 2018, 13(3): e0194209. doi:10.1371/journal.pone.0194209.
[36] 张丰菊, 李玉. 角膜屈光手术术前的筛查要点[J]. 山东大学耳鼻喉眼学报, 2020,34(2): 7-12. doi:10.6040/j.issn.1673-3770.1.2020.014. ZHANG Fengju, LI Yu. Key criteria for screening before corneal refractive surgery[J]. J Otolaryngol Ophthalmol Shandong Univ, 2020,34(2): 7-12. doi:10.6040/j.issn.1673-3770.1.2020.014.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed