Femtoszekundumlézeres keratoplasztika = Femtosecond laser-assisted keratoplasty

Absztrakt: Bevezetes es celkitűzes: A femtoszekundumlezer-asszisztalt perforalo keratoplasztika műteti eredmenyeinek bemutatasa. Betegek es modszer: Huszonot szemen 25 műtetet vegeztunk, az indikaciok a kovetkezők voltak: pseudophakias bullosus keratopathia (n = 10), keratoconus (n = 4), dystrophia corneae (n = 5), leucoma corneae (n = 4), opacitas zonularis (n = 2). Mind a donor, mind a recipiens trepanalasat VisuMax femtoszekundumos lezerkeszulek (Carl Zeiss Meditec AG, Jena, Nemetorszag) segitsegevel vegeztuk. Minden alkalommal a donorszovetet trepanaltuk ki elsőkent, mesterseges elulső csarnok segitsegevel (Moria, Antony, Franciaorszag). A műteti terv felallitasahoz, majd a posztoperativ szakban kulonboző cornealis kepalkoto vizsgalatokat vegeztunk. A torőerőt corneatopograffal (TMS-4, Tomey, Nurnberg, Nemetorszag) es Scheimpflug-kameraval (Pentacam HR, Oculus, Wetzlar, Nemetorszag) mertuk meg. A centralis corneavastagsagot Pentacammal, az endothelialis sejtszamot spekular mikroszkoppal (SP3000P, Topcon, Tokio, Japan) hataroztuk meg. A cornea szerkezetet az elulső szegmentum vizsgalatara alkalmas optikaikoherencia-tomograffal (Visante, Carl Zeiss Meditec AG) tanulmanyoztuk. A vizsgalatokat az első evben negy alkalommal, majd evente vegeztuk el. A kovetesi idő egysegesen 3 ev volt. Eredmenyek: A műtet utani atlagos korrigalt, decimalis tavoli latoelesseg folyamatosan javult, a műtet előtti 0,1 ± 0,1-ről a kovetesi idő vegere 0,71 ± 0,18-re (p = 0,03). A kovetesi periodusban valamennyi transzplantatum tiszta maradt, immunrejekcio nem fordult elő. A topografias astigmatismus az első honapban 4,5 ± 3,1 D volt, osszessegeben csokkenő tendenciat mutatott, de mar nem valtozott szignifikansan a 3 eves kovetes alatt. Az atlagos centralis corneavastagsag a 3 ev alatt 60 µm-en belul valtozott, szignifikans elterest itt sem mutattunk ki az első honapi (564 ± 52 µm), a koztes es a 3. evi atlagertek (596 ± 64 µm) kozott (p = 0,1). Az atlagos centralis endothelialis sejtszam folyamatosan csokkent, majd stagnalt, de szignifikans elterest itt sem figyeltunk meg az első (1641 ± 433 sejt/mm 2 ) es az utolso kontroll (1220 ± 391 sejt/mm 2 , p = 0,1) ertekei kozott. Kovetkeztetesek: A femtoszekundumlezer-asszisztalt szaruhartya-atultetes soran a donor es a recipiens trepanacioja automatikusan, nagy pontossaggal tortenik. A preciz metszesfelszin kivalo sebegyesitest es sebgyogyulast eredmenyez. A műteten atesett betegek rehabilitacioja mind funkcionalis, mind anatomiai szempontbol kedvező es gyors. Orv Hetil. 2018; 159(17): 671–676. | Abstract: Introduction and aim: To present our results on femtosecond laser-assisted penetrating keratoplasty. Patients and method: Twenty-five eyes of 25 patients underwent surgery with the following indications: pseudophakic bullous keratopathy (n = 10), keratoconus (n = 4), corneal dystrophy (n = 5), corneal scar (n = 4), band keratopathy (n = 2). Trephination of both the donor and recipient corneas were performed with VisuMax femtosecond laser device (Carl Zeiss Meditec AG, Jena, Germany). In each case, trephinaton of the donor tissue was performed first with an artificial anterior chamber (Moria, Antony, France). For the surgical plan and in the postoperative period we obtained different corneal imaging modalities. The corneal power was measured with corneal topography (TMS-4, Tomey, Nurnberg, Germany) and Scheimpflug tomography (Pentacam HR, Oculus, Wetzlar, Germany). The central corneal thickness was evaluated with Pentacam and corneal endothelial cell density was measured with specular microscopy (SP3000P, Topcon, Tokyo, Japan). The corneal structure was imaged with anterior segment optical coherence tomography (Visante, Carl Zeiss Meditec AG). All measurements were performed every 3 months in the first year and yearly thereafter. The follow-up period was 3 years in every case. Results: The corrected decimal visual acuity showed an improvement from a preoperative 0.1 ± 0.1 to a postoperative 0.71 ± 0.18 value at the end of the follow-up period (p = 0.03). All corneal grafts maintained their transparency, there were no immunological rejection during the follow-up. Topographical astigmatism was 4.5 ± 3.1 D in the first month; it showed a decreasing tendency, but there was no significant change in the 3-year period. The mean central corneal thickness changed with 60 µm during the follow-up; there was no significant difference between the first month (564 ± 52 µm) and the third year (596 ± 64 µm) mean pachymetry values (p = 0.1). The mean endothelial cell density decreased first, then remained stable, but did not change significantly from the first (1641 ± 433 cells/mm 2 ) to the last postoperative visit (1220 ± 391 cells/mm 2 , p = 0.1). Conclusions: In the case of femtosecond laser-assisted penetrating keratoplasty, trephination of the donor and recipient cornea is performed automatically in a highly precise fashion. The accurate cutting surface provides excellent wound apposition and healing. Both anatomical and functional rehabilitation of patients undergoing surgery are favourable and fast. Orv Hetil. 2018; 159(17): 671–676.