前部深板层角膜移植术后泪新月高度、泪膜厚度及角膜上皮厚度的评估（英文）
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摘要
目的:评估前部深板层角膜移植(DALK)术后的下泪新月高度(LTMH)、中央泪膜厚度(CTFT)及中央角膜上皮厚度(CCET)。创新点:首次利用高清光学相干断层扫描成像技术(HD-OCT)定量测量DALK术后的CCET、CTFT和LTMH,并发现各个参数之间及与其他临床数据的相关性。方法:回顾性横断面分析20例单眼DALK术后3月以上的患者。使用HD-OCT定量分析并比较术眼和对侧未手术眼的LTMH、CTFT和CCET。对各个OCT参数之间及与年龄、术后时间、植片直径、植床直径和残余缝线数量进行相关性分析。结论:本研究显示,圆锥角膜患者的中央角膜上皮倾向变薄;DALK术后角膜上皮随着时间推移而持续再生;与对侧未手术眼相比,DALK并不引起显著的泪液量变化。因此,术后的泪液功能可能取决于患者的整体状况而非年龄、性别、植片/植床直径、术后时间或残余缝线。
Objective: To assess the lower tear meniscus height(LTMH), central tear film thickness(CTFT), and central corneal epithelial thickness(CCET) after deep anterior lamellar keratoplasty(DALK). Methods: This was a retrospective cross-sectional study of 20 patients who had DALK in one eye over a three-month period. LTMH, CTFT, and CCET of the operated eyes and the unoperated fellow eyes were measured using high-definition optical coherence tomography(HD-OCT). Correlations between three OCT assessments and age, time following surgery, graft size, bed size, and the number of residual sutures were analyzed. Results: Compared to patients with keratoconus, patients with other corneal conditions had significantly higher CCET in the fellow eye(P=0.024). For all patients, CCET in the operated eye was significantly negatively correlated with the number of residual sutures(R=-0.579, P=0.008), and was significantly positively correlated with time following surgery(R=0.636, P=0.003). In the fellow eye, a significant positive correlation was found between age and CCET(R=0.551, P=0.012), and a significant negative correlation between age and CTFT(R=-0.491, P=0.028). LTMH was found to be significantly correlated between operated and fellow eyes(R=0.554, P=0.011). There was no significant correlation between LTMH and age, bed/graft size, time following surgery, or residual sutures(all possible correlations, P>0.05). Conclusions: Patients with keratoconus tend to have a thinner central corneal epithelium. Corneal epithelium keeps regenerating over time after DALK. DALK did not induce a significant change in tear volume compared with the fellow eye. Postoperative tear function might depend on an individual's general condition, rather than on age, gender, bed/graft size, time following surgery, or residual sutures.
Objective: To assess the lower tear meniscus height(LTMH), central tear film thickness(CTFT), and central corneal epithelial thickness(CCET) after deep anterior lamellar keratoplasty(DALK). Methods: This was a retrospective cross-sectional study of 20 patients who had DALK in one eye over a three-month period. LTMH, CTFT, and CCET of the operated eyes and the unoperated fellow eyes were measured using high-definition optical coherence tomography(HD-OCT). Correlations between three OCT assessments and age, time following surgery, graft size, bed size, and the number of residual sutures were analyzed. Results: Compared to patients with keratoconus, patients with other corneal conditions had significantly higher CCET in the fellow eye(P=0.024). For all patients, CCET in the operated eye was significantly negatively correlated with the number of residual sutures(R=-0.579, P=0.008), and was significantly positively correlated with time following surgery(R=0.636, P=0.003). In the fellow eye, a significant positive correlation was found between age and CCET(R=0.551, P=0.012), and a significant negative correlation between age and CTFT(R=-0.491, P=0.028). LTMH was found to be significantly correlated between operated and fellow eyes(R=0.554, P=0.011). There was no significant correlation between LTMH and age, bed/graft size, time following surgery, or residual sutures(all possible correlations, P>0.05). Conclusions: Patients with keratoconus tend to have a thinner central corneal epithelium. Corneal epithelium keeps regenerating over time after DALK. DALK did not induce a significant change in tear volume compared with the fellow eye. Postoperative tear function might depend on an individual's general condition, rather than on age, gender, bed/graft size, time following surgery, or residual sutures.
引文
Arriola-Villalobos P,Fernández-Vigo JI,Díaz-Valle D,et al.,2015.Assessment of lower tear meniscus measurements obtained with Keratograph and agreement with Fourierdomain optical-coherence tomography.Br J Ophthalmol,99(8):1120-1125.https://doi.org/10.1136/bjophthalmol-2014-306453
Bunya VY,Fuerst NM,Pistilli M,et al.,2015.Variability of tear osmolarity in patients with dry eye.JAMA Ophthalmol,133(6):662-667.https://doi.org/10.1001/jamaophthalmol.2015.0429
Campbell C,2005.The effect of tear film on higher order corrections applied to the corneal surface during wavefrontguided refractive surgery.J Refract Surg,21(5):S519-S524.https://doi.org/10.3928/1081-597X-20050901-20
Cui XH,Hong JX,Wang F,et al.,2014.Assessment of corneal epithelial thickness in dry eye patients.Optom Vis Sci,91(12):1446-1454.https://doi.org/10.1097/OPX.0000000000000417
Czajkowski G,Kaluzny BJ,Laudencka A,et al.,2012.Tear meniscus measurement by spectral optical coherence tomography.Optom Vis Sci,89(3):336-342.https://doi.org/10.1097/OPX.0b013e318242042b
Darwish T,Brahma A,Efron N,et al.,2007.Subbasal nerve regeneration after penetrating keratoplasty.Cornea,26(8):935-940.https://doi.org/10.1097/ICO.0b013e3180de493f
Diez-Feijóo E,Durán JA,2015.Optical coherence tomography findings in recurrent corneal erosion syndrome.Cornea,34(3):290-295.https://doi.org/10.1097/ICO.0000000000000334
Francoz M,Karamoko I,Baudouin C,et al.,2011.Ocular surface epithelial thickness evaluation with spectraldomain optical coherence tomography.Invest Ophthalmol Vis Sci,52(12):9116-9123.https://doi.org/10.1167/iovs.11-7988
Hara S,Kojima T,Dogru M,et al.,2013.The impact of tear functions on visual outcome following keratoplasty in eyes with keratoconus.Graefes Arch Clin Exp Ophthalmol,251(7):1763-1770.https://doi.org/10.1007/s00417-013-2307-6
Hu L,Xie W,Liu J,et al.,2015.Tear menisci and corneal subbasal nerve density in patients after laser in situ keratomileusis.Eye Contact Lens,41(1):51-57.https://doi.org/10.1097/ICL.0000000000000062
Kanellopoulos AJ,Asimellis G,2014.In vivo 3-dimensional corneal epithelial thickness mapping as an indicator of dry eye:preliminary clinical assessment.Am J Ophthalmol,157(1):63-68.e2.https://doi.org/10.1016/j.ajo.2013.08.025
Kung JS,Sáles CS,Manche EE,2014.Corneal sensation and dry eye symptoms after conventional versus inverted side-cut femtosecond LASIK:a prospective randomized study.Ophthalmology,121(12):2311-2316.https://doi.org/10.1016/j.ophtha.2014.07.015
Lee M,Ahn J,2016.Effects of central corneal stromal thickness and epithelial thickness on intraocular pressure using goldmann applanation and non-contact tonometers.PLo SONE,11(3):e0151868.https://doi.org/10.1371/journal.pone.0151868
Levitt AE,Galor A,Weiss JS,et al.,2015.Chronic dry eye symptoms after LASIK:parallels and lessons to be learned from other persistent post-operative pain disorders.Mol Pain,11(1):21.https://doi.org/10.1186/s12990-015-0020-7
Li Y,Tan O,Brass R,et al.,2012.Corneal epithelial thickness mapping by Fourier-domain optical coherence tomography in normal and keratoconic eyes.Ophthalmology,119(12):2425-2433.https://doi.org/10.1016/j.ophtha.2012.06.023
Liang Q,Liang H,Liu H,et al.,2016.Ocular surface epithelial thickness evaluation in dry eye patients:clinical correlations.J Ophthalmol,2016:1628469.https://doi.org/10.1155/2016/1628469
Lin X,Xu B,Sun Y,et al.,2014.Comparison of deep anterior lamellar keratoplasty and penetrating keratoplasty with respect to postoperative corneal sensitivity and tear film function.Graefes Arch Clin Exp Ophthalmol,252(11):1779-1787.https://doi.org/10.1007/s00417-014-2748-6
Murdoch IE,Morris SS,Cousens SN,1998.People and eyes:statistical approaches in ophthalmology.Br J Ophthalmol,82(8):971-973.https://doi.org/10.1136/bjo.82.8.971
Nichols KK,Mitchell GL,Zadnik K,2004.The repeatability of clinical measurements of dry eye.Cornea,23(3):272-285.https://doi.org/10.1097/00003226-200404000-00010
Savini G,Prabhawasat P,Kojima T,et al.,2008.The challenge of dry eye diagnosis.Clin Ophthalmol,2(1):31-55.https://doi.org/10.2147/OPTH.S1496
Schmidl D,Schmetterer L,Witkowska KJ,et al.,2015.Tear film thickness after treatment with artificial tears in patients with moderate dry eye disease.Cornea,34(4):421-426.https://doi.org/10.1097/ICO.0000000000000358
Shimmura S,Tsubota K,2006.Deep anterior lamellar keratoplasty.Curr Opin Ophthalmol,17(4):349-355.https://doi.org/10.1097/01.icu.0000233953.09595.91
Situ P,Simpson TL,2010.Interaction of corneal nociceptive stimulation and lacrimal secretion.Invest Ophthalmol Vis Sci,51(11):5640-5645.https://doi.org/10.1167/iovs.10-5502
Tao A,Shen M,Wang J,et al.,2010.Upper and lower tear menisci after laser in situ keratomileusis.Eye Contact Lens,36(2):81-85.https://doi.org/10.1097/ICL.0b013e3181d0b76b
Tervo T,Vannas A,Tervo K,et al.,1985.Histochemical evidence of limited reinnervation of human corneal grafts.Acta Ophthalmol(Copenh),63(2):207-214.https://doi.org/10.1111/j.1755-3768.1985.tb01535.x
Trabucchi G,Brancato R,Verdi M,et al.,1994.Corneal nerve damage and regeneration after excimer laser photokeratectomy in rabbit eyes.Invest Ophthalmol Vis Sci,35(1):229-235.
Watson SL,Ramsay A,Dart JK,et al.,2004.Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus.Ophthalmology,111(9):1676-1682.https://doi.org/10.1016/j.ophtha.2004.02.010
Werkmeister RM,Alex A,Kaya S,et al.,2013.Measurement of tear film thickness using ultrahigh-resolution optical coherence tomography.Invest Ophthalmol Vis Sci,54(8):5578-5583.https://doi.org/10.1167/iovs.13-11920
Wu SQ,Zhou P,Zhang B,et al.,2012.Long-term comparison of full-bed deep lamellar keratoplasty with penetrating keratoplasty in treating corneal leucoma caused by herpes simplex keratitis.Am J Ophthalmol,153(2):291-299.e2.https://doi.org/10.1016/j.ajo.2011.07.020
Xie W,2016.Recent advances in laser in situ keratomileusisassociated dry eye.Clin Exp Optom,99(2):107-112.https://doi.org/10.1111/cxo.12361
Xie W,Zhang D,Chen J,et al.,2014.Tear menisci after laser in situ keratomileusis with mechanical microkeratome and femtosecond laser.Invest Ophthalmol Vis Sci,55(9):5806-5812.https://doi.org/10.1167/iovs.13-13669
Xu YS,Xie WJ,Yao YF,2017.Satisfactory clinical outcome following delayed repositioning of a traumatic postLASIK flap with dislocation and shrinkage managed by irrigation,stretching,and debridement.J Zhejiang Univ Sci-B(Biomed&Biotechnol),18(6):539-543.https://doi.org/10.1631/jzus.B1600363
Xu Z,Jiang J,Yang C,et al.,2016.Value of corneal epithelial and Bowman’s layer vertical thickness profiles generated by UHR-OCT for sub-clinical keratoconus diagnosis.Sci Rep,6:31550.https://doi.org/10.1038/srep31550
Yao YF,2008.A novel technique for performing full-bed deep lamellar keratoplasty.Cornea,27(Suppl 1):S19-S24.https://doi.org/10.1097/ICO.0b013e31817f445f
Yao YF,Zhang B,Zhou P,et al.,2002.Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage.Ophthalmology,109(11):2011-2017.https://doi.org/10.1016/S0161-6420(02)01258-7
Yokoi N,Bron AJ,Tiffany JM,et al.,2004.Relationship between tear volume and tear meniscus curvature.Arch Ophthalmol,122(9):1265-1269.https://doi.org/10.1001/archopht.122.9.1265
Zhang F,Deng S,Guo N,et al.,2012.Confocal comparison of corneal nerve regeneration and keratocyte reaction between FS-LASIK,OUP-SBK,and conventional LASIK.Invest Ophthalmol Vis Sci,53(9):5536-5544.https://doi.org/10.1167/iovs.11-8786
Zhang YM,Wu SQ,Yao YF,2013.Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus.J Zhejiang Univ-Sci B(Biomed&Biotechnol),14(5):438-450.https://doi.org/10.1631/jzus.B1200272
Bunya VY,Fuerst NM,Pistilli M,et al.,2015.Variability of tear osmolarity in patients with dry eye.JAMA Ophthalmol,133(6):662-667.https://doi.org/10.1001/jamaophthalmol.2015.0429
Campbell C,2005.The effect of tear film on higher order corrections applied to the corneal surface during wavefrontguided refractive surgery.J Refract Surg,21(5):S519-S524.https://doi.org/10.3928/1081-597X-20050901-20
Cui XH,Hong JX,Wang F,et al.,2014.Assessment of corneal epithelial thickness in dry eye patients.Optom Vis Sci,91(12):1446-1454.https://doi.org/10.1097/OPX.0000000000000417
Czajkowski G,Kaluzny BJ,Laudencka A,et al.,2012.Tear meniscus measurement by spectral optical coherence tomography.Optom Vis Sci,89(3):336-342.https://doi.org/10.1097/OPX.0b013e318242042b
Darwish T,Brahma A,Efron N,et al.,2007.Subbasal nerve regeneration after penetrating keratoplasty.Cornea,26(8):935-940.https://doi.org/10.1097/ICO.0b013e3180de493f
Diez-Feijóo E,Durán JA,2015.Optical coherence tomography findings in recurrent corneal erosion syndrome.Cornea,34(3):290-295.https://doi.org/10.1097/ICO.0000000000000334
Francoz M,Karamoko I,Baudouin C,et al.,2011.Ocular surface epithelial thickness evaluation with spectraldomain optical coherence tomography.Invest Ophthalmol Vis Sci,52(12):9116-9123.https://doi.org/10.1167/iovs.11-7988
Hara S,Kojima T,Dogru M,et al.,2013.The impact of tear functions on visual outcome following keratoplasty in eyes with keratoconus.Graefes Arch Clin Exp Ophthalmol,251(7):1763-1770.https://doi.org/10.1007/s00417-013-2307-6
Hu L,Xie W,Liu J,et al.,2015.Tear menisci and corneal subbasal nerve density in patients after laser in situ keratomileusis.Eye Contact Lens,41(1):51-57.https://doi.org/10.1097/ICL.0000000000000062
Kanellopoulos AJ,Asimellis G,2014.In vivo 3-dimensional corneal epithelial thickness mapping as an indicator of dry eye:preliminary clinical assessment.Am J Ophthalmol,157(1):63-68.e2.https://doi.org/10.1016/j.ajo.2013.08.025
Kung JS,Sáles CS,Manche EE,2014.Corneal sensation and dry eye symptoms after conventional versus inverted side-cut femtosecond LASIK:a prospective randomized study.Ophthalmology,121(12):2311-2316.https://doi.org/10.1016/j.ophtha.2014.07.015
Lee M,Ahn J,2016.Effects of central corneal stromal thickness and epithelial thickness on intraocular pressure using goldmann applanation and non-contact tonometers.PLo SONE,11(3):e0151868.https://doi.org/10.1371/journal.pone.0151868
Levitt AE,Galor A,Weiss JS,et al.,2015.Chronic dry eye symptoms after LASIK:parallels and lessons to be learned from other persistent post-operative pain disorders.Mol Pain,11(1):21.https://doi.org/10.1186/s12990-015-0020-7
Li Y,Tan O,Brass R,et al.,2012.Corneal epithelial thickness mapping by Fourier-domain optical coherence tomography in normal and keratoconic eyes.Ophthalmology,119(12):2425-2433.https://doi.org/10.1016/j.ophtha.2012.06.023
Liang Q,Liang H,Liu H,et al.,2016.Ocular surface epithelial thickness evaluation in dry eye patients:clinical correlations.J Ophthalmol,2016:1628469.https://doi.org/10.1155/2016/1628469
Lin X,Xu B,Sun Y,et al.,2014.Comparison of deep anterior lamellar keratoplasty and penetrating keratoplasty with respect to postoperative corneal sensitivity and tear film function.Graefes Arch Clin Exp Ophthalmol,252(11):1779-1787.https://doi.org/10.1007/s00417-014-2748-6
Murdoch IE,Morris SS,Cousens SN,1998.People and eyes:statistical approaches in ophthalmology.Br J Ophthalmol,82(8):971-973.https://doi.org/10.1136/bjo.82.8.971
Nichols KK,Mitchell GL,Zadnik K,2004.The repeatability of clinical measurements of dry eye.Cornea,23(3):272-285.https://doi.org/10.1097/00003226-200404000-00010
Savini G,Prabhawasat P,Kojima T,et al.,2008.The challenge of dry eye diagnosis.Clin Ophthalmol,2(1):31-55.https://doi.org/10.2147/OPTH.S1496
Schmidl D,Schmetterer L,Witkowska KJ,et al.,2015.Tear film thickness after treatment with artificial tears in patients with moderate dry eye disease.Cornea,34(4):421-426.https://doi.org/10.1097/ICO.0000000000000358
Shimmura S,Tsubota K,2006.Deep anterior lamellar keratoplasty.Curr Opin Ophthalmol,17(4):349-355.https://doi.org/10.1097/01.icu.0000233953.09595.91
Situ P,Simpson TL,2010.Interaction of corneal nociceptive stimulation and lacrimal secretion.Invest Ophthalmol Vis Sci,51(11):5640-5645.https://doi.org/10.1167/iovs.10-5502
Tao A,Shen M,Wang J,et al.,2010.Upper and lower tear menisci after laser in situ keratomileusis.Eye Contact Lens,36(2):81-85.https://doi.org/10.1097/ICL.0b013e3181d0b76b
Tervo T,Vannas A,Tervo K,et al.,1985.Histochemical evidence of limited reinnervation of human corneal grafts.Acta Ophthalmol(Copenh),63(2):207-214.https://doi.org/10.1111/j.1755-3768.1985.tb01535.x
Trabucchi G,Brancato R,Verdi M,et al.,1994.Corneal nerve damage and regeneration after excimer laser photokeratectomy in rabbit eyes.Invest Ophthalmol Vis Sci,35(1):229-235.
Watson SL,Ramsay A,Dart JK,et al.,2004.Comparison of deep lamellar keratoplasty and penetrating keratoplasty in patients with keratoconus.Ophthalmology,111(9):1676-1682.https://doi.org/10.1016/j.ophtha.2004.02.010
Werkmeister RM,Alex A,Kaya S,et al.,2013.Measurement of tear film thickness using ultrahigh-resolution optical coherence tomography.Invest Ophthalmol Vis Sci,54(8):5578-5583.https://doi.org/10.1167/iovs.13-11920
Wu SQ,Zhou P,Zhang B,et al.,2012.Long-term comparison of full-bed deep lamellar keratoplasty with penetrating keratoplasty in treating corneal leucoma caused by herpes simplex keratitis.Am J Ophthalmol,153(2):291-299.e2.https://doi.org/10.1016/j.ajo.2011.07.020
Xie W,2016.Recent advances in laser in situ keratomileusisassociated dry eye.Clin Exp Optom,99(2):107-112.https://doi.org/10.1111/cxo.12361
Xie W,Zhang D,Chen J,et al.,2014.Tear menisci after laser in situ keratomileusis with mechanical microkeratome and femtosecond laser.Invest Ophthalmol Vis Sci,55(9):5806-5812.https://doi.org/10.1167/iovs.13-13669
Xu YS,Xie WJ,Yao YF,2017.Satisfactory clinical outcome following delayed repositioning of a traumatic postLASIK flap with dislocation and shrinkage managed by irrigation,stretching,and debridement.J Zhejiang Univ Sci-B(Biomed&Biotechnol),18(6):539-543.https://doi.org/10.1631/jzus.B1600363
Xu Z,Jiang J,Yang C,et al.,2016.Value of corneal epithelial and Bowman’s layer vertical thickness profiles generated by UHR-OCT for sub-clinical keratoconus diagnosis.Sci Rep,6:31550.https://doi.org/10.1038/srep31550
Yao YF,2008.A novel technique for performing full-bed deep lamellar keratoplasty.Cornea,27(Suppl 1):S19-S24.https://doi.org/10.1097/ICO.0b013e31817f445f
Yao YF,Zhang B,Zhou P,et al.,2002.Autologous limbal grafting combined with deep lamellar keratoplasty in unilateral eye with severe chemical or thermal burn at late stage.Ophthalmology,109(11):2011-2017.https://doi.org/10.1016/S0161-6420(02)01258-7
Yokoi N,Bron AJ,Tiffany JM,et al.,2004.Relationship between tear volume and tear meniscus curvature.Arch Ophthalmol,122(9):1265-1269.https://doi.org/10.1001/archopht.122.9.1265
Zhang F,Deng S,Guo N,et al.,2012.Confocal comparison of corneal nerve regeneration and keratocyte reaction between FS-LASIK,OUP-SBK,and conventional LASIK.Invest Ophthalmol Vis Sci,53(9):5536-5544.https://doi.org/10.1167/iovs.11-8786
Zhang YM,Wu SQ,Yao YF,2013.Long-term comparison of full-bed deep anterior lamellar keratoplasty and penetrating keratoplasty in treating keratoconus.J Zhejiang Univ-Sci B(Biomed&Biotechnol),14(5):438-450.https://doi.org/10.1631/jzus.B1200272
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