Background Postoperative ametropia, especially large astigmatism after deep anterior lamellar keratoplasty (DALK) for keratoconus often results in poor visual acuity.Though postoperative ametropia can be corrected by wearing glasses or performing corneal refractive surgery, the visual quality of patients is still poor, and the operations are difficult to implement because of insufficient corneal thickness.Toric intraocular collamer lens (TICL) implantation appears to have good corrective efficacy on severe astigmatism,but the research on the eyes after DALK is still less.Objective This study was to evaluate the efficacy and safety of TICL implantation for the ametropic eyes following DALK for keratoconus.Methods This study protocol was approved by Ethic Commission of Nanjing Drum Tower Hospital,and written informed consent was obtained from each patient prior to any medical procedure.A self-controlled serial observational research was carried out.Eight ametropic eyes of 8 patients who received the DALK for keratoconus before 18 months were enrolled in Nanjing Drum Tower Hospital from August 201 1 to March 2012, with the spherical diopter range from 0 D to-7.5 D and cylindrical diopter range from-2.5 D to-6.0 D.TICL implantation was performed on the eyes.The eye examinations were carried out before surgery and 1 week,3 months,6 months, 1 year and 2 years after surgery,including uncorrected visual acuity (UCVA) ,best corrected visual acuity (BCVA) ,comprehensive optometry, corneal astigmatism degree, the central corneal thickness and anterior chamber depth (ACD), corneal endothelial cell counts (ECD) ,intraocular pressure.The examination outcomes were compared before and after surgery.The intraoperative and postoperative complications were observed to evaluate the safety of TICL implantation for the ametropic eyes following DALK for keratoconus.Results The UCVA and BCVA were obviously improved at 6 months after TICL implantation in comparison with before surgery and maintained stable during the follow-up duration.The mean spherical diopter was from-0.5 D to-1.0 D and the mean cylindrical diopter was from-0.5 D to-2.0 D after surgery.The corneal endothelial cell counts were (2 520.2 ± 307.2) , (2 496.2 ± 306.2) , (2 469.6±304.5) , (2 432.0 ± 305.4), (2 383.4 ± 309.4)/mm2, and the intraoeular pressures were (14.57 ± 3.75), (16.62±4.21), (16.57±3.56), (15.66±3.37), (15.13±3.48) mmHg, showing insignificant differences among different time points (F =0.375,P =0.825;F =9.871, P =0.394).No significant differences were found in mean ACD and intraocular pressure between before and after surgery (t =1.56 ,P =0.16).The axial deviation of TICL was less than 10° in all the operated eyes 6 months after surgery.No intraoperative and postoperative complications were found during the follow-up duration.Conclusions TICL implantation is a safe and effective alternative and viable approach to myopic and astigmatism patients following DALK for keratoconus.%背景 圆锥角膜患者行深板层角膜移植术(DALK)后的屈光不正常导致术后裸眼视力不佳,尤其是高度散光.这样的屈光不正虽可通过佩戴框架眼镜或行角膜屈光手术矫正,但术后视觉质量差或因角膜厚度不足等难以实施角膜屈光手术.研究证实环曲面后房型有晶状体眼人工晶状体(TICL)植入术对屈光不正,尤其是高度散光有较好的矫正作用,但其在DALK术后的应用研究较少. 目的 探讨TICL植入术矫治DALK术后的屈光不正,特别是高度散光的有效性和安全性.方法 采用自身对照系列病例观察法,纳入2011年8月至2012年3月在南京大学医学院附属鼓楼医院眼科中心圆锥角膜DALK术后18个月以上且拆线3个月以上的屈光不正患者8例8眼,其球镜度数为0～-7.5D,柱镜度数为-2.5～-6.0D.所有患者均行TICL植入术,分别于术前、术后1周、术后3个月、6个月、1年和2年检测术眼裸眼视力、最佳矫正视力(BCVA).采用CV-3000综合验光仪进行验光;采用OCULYZERⅡ测定角膜散光、角膜厚度及前房深度;采用ST3000P角膜内皮细胞计数仪检测角膜内皮细胞数(ECD);采用Goldman压平眼压计测量眼压,比较术前及术后不同时间点的眼压检测结果.观察TICL植入术术中或术后的并发症,评价手术的安全性.结果 术后6个月,所有术眼的UCVA及BCVA均好于术前,术后球镜度数和柱镜度数较术前均有不同程度降低,术后球镜度为-0.5～-1.0D,柱镜度为-0.5～-2.0 D.术眼术前及术后1周、6个月、1年和2年的ECD分别为(2 520.2±307.2)、(2 496.2±306.2)、(2 469.6±304.5)、(2 432.0±305.4)和(2 383.4±309.4)个/mm2,眼压分别为(14.57±3.75)、(16.62±4.21)、(16.57±3.56)、(15.66±3.37)和(15.13±3.48)mmHg,总体比较差异均无统计学意义(F=0.375,P=0.825;F=9.871,P=0.394);术前及术后2年术眼的前房深度分别为(3.15±0.03)和(3.12±0.03) mm,差异无统计学意义(t=1.56,P=0.16).术后6个月所有术眼TICL轴位偏差均小于10°且趋于稳定.所有术眼术中及术后均未发生严重并发症. 结论 TICL植入术可用于圆锥角膜DALK源性高度散光的矫正,其临床疗效可靠,安全性好.
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