Офтальмохирургия. 2020; : 14-17
Использование фемтосекундрого лазера VisuMax для проведения кросслинкинга роговичного коллагена
https://doi.org/10.25276/0235-4160-2020-1-14-17Аннотация
Актуальность. Кросслинкинг роговичного коллагена является способом лечения прогрессирующего кератоконуса, в результате которого происходит «уплотнение» или увеличение прочности стромы роговицы. Высокие функциональные результаты и сокращенные сроки послеоперационного периода у пациентов при проведении кросслинкинга с использованием фемтосекундного лазера определяют перспективы дальнейшего изучения данного направления.
Цель. Изучить условия и применить метод фемтокросслинкинга на основе стандартных опций формирования лоскута на фемтолазерной установке VisuMax.
Материал и методы. Под нашим наблюдением находилось 20 пациентов с прогрессирующим кератоконусом (20 глаз), которым проводилась операция фемтокросслинкинга роговичного коллагена с использованием фемтолазера VisuMax. Все пациенты проходили стандартное предоперационное офтальмологическое обследование (визометрия, тонометрия, кераторефрактометрия, пахиметрия, кератотопография). Факт прогрессирования кератоконуса был установлен на основании динамического наблюдения не менее 6 мес.
Результаты. Особенностями метода фемтокросслинкинга роговичного коллагена на фемтолазерной установке VisuMax являются: 1) расширение ножки лоскута в операционных настройках (угловой размер перешейка увеличен до 320°); 2) формирование с помощью фемтолазера кругового роговичного кармана параллельно передней поверхности и одного дугообразного роговичного разреза с параметрами глубины 140–160 мкм, диаметром кармана и дугообразного разреза 7,9–8,7 мм. У всех пациентов (20 глаз, 100%) была достигнута стабилизация эктатического процесса через 6 и 12 мес. наблюдения.
Выводы. Определены условия для применения лазерной установки VisuMax (Carl Zeiss) по программе «FLAP» в операции фемтокросслинкинга роговичного коллагена. Преимущество данного метода заключается в упрощении классического способа выполнения кросслинкинга и повышении его эффективности.
Список литературы
1. Mohammed Z, Allon B, Neda S et al. ASCRS Cornea Clinical Committee. Reshaping procedures for the surgical management of corneal ectasia. J. Cataract. Refract. Surg. 2015;41: 842–72. doi.org/10.1016/j. jcrs.2015.03.010.
2. Cresta FB, Cresta ML, Alves MR. Corneal collagen cross-linking. Е-Oftalmo. CBO. 2017;3: 1–6. doi. org/10.17545/e-oftalmo.cbo/2017.92.
3. Wollensak G, Spoerl E, Seiler T. Riboflavin/ ultraviolet-a-inducedcollagen crosslinking for the treatment of keratoconus. Am J. Ophthalmol. 2003;135: 620–7. doi.org/10.1016/s0002-9394(02)02220-1.
4. Koller T, Pajic B, Vinciguerra P, et al. Flattening of the cornea after collagen crosslinking for keratoconus. J. Cataract. Refract. Surg. 2011;37: 1488–92. doi. org/10.1016/j.jcrs.2011.03.041.
5. Randleman JB, Khandelwal SS, Hafezi F. Corneal cross-linking. J. Surv. Ophthalmol. 2015;60: 509–23. doi. org/10.1016/j.survophthal.2015.04.002.
6. Vinciguerra P, Randleman JB, Romano V, et al. Transepithelialion to phoresis corneal collagen crosslinking for progressive keratoconus:initial clinical outcomes. J. Refract. Surg. 2014;30: 746–753. doi.org/ 10.3928/1081597X-20141021-06. 7.
7. Kohlhaas M, Spoerl E, Schilde T, et al. Biomechanical evidence of the distribution of crosslinks in corneas treated with riboflavin and ultraviolet a light. J. Cataract. Refract. Surg. 2006;32: 279–83. doi. org/10.1016/j.jcrs.2005.12.092.
8. Wollensak G, Spoerl E, Seiler T. Stress – strain measurements of human and porcine corneas after riboflavin-ultraviolet-A-induced cross-linking. J. Cataract. Refract. Surg. 2003;29(9): 1780–5.
9. Alhayek A, Lu PR. Corneal collagen crosslinking in keratoconus and other eye disease. Int. J. Ophthalmol. 2015;18: 407–18. doi.org/10.3980/j.issn.22223959.2015.02.35.
10. Raiskup F, Spoerl E. Corneal crosslinking with riboflavin and ultraviolet A. Part II. Clinical indications and results. J. Ocul. Surf. 2013; 11: 93–108. doi. org/10.1016/j.jtos.2013.01.003.
11. Vinciguerra P, Albe E, Trazza S, et al. Refractive, topographic, tomographic and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. J. Ophthalmology. 2009;116: 369–78. doi.org/10.1016/j. ophtha.2008.09.048.
12. Eljarrat-Binstock E, Domb AJ. Iontophoresis: a non-invasive ocular drug delivery. J. Control Release. 2006;110: 479–89. https://doi.org/10.1016/j. jconrel.2005.09.049
13. Leccisotti A, Islam T. Transepithelial corneal collagen cross-linking in keratoconus. J. Refract. Surg. 2010;26: 942–8. doi.org/10.3928/108159 7X-20100212-09.
14. Samaras K, O’Brart D, Doutch J, et al. Effect of epithelial retention and removal on riboflavin absorption in porcine corneas. J. Refract. Surg. 2009;25: 771–5. doi.org/10.3928/1081597X-20090813-03.
15. Sarkar J, Chaudhary S, Namavari A, et al. Corneal neurotoxicity due to topical benzalkonium chloride. J. Invest. Ophthalmol. Vis. Sci. 2012;53(4): 1792–802. doi. org/10.1167/iovs.11-8775.
16. Краснер К.Ю., Бурилов К.Б., Черных Д.В. и др. Рефракционная операция Relex Smile у пациента после циркляжа с миопической рефракцией (клинический случай). Практическая медицина. 2018;16: 140–3. [Krasner KU, Burilov KB, Chernykh DV, et al. Relex Smile refractive operation in a patient after scleral buckle with myopic refraction (clinical case). Prakticheskaya medicina. 2018;16: 140–3. (In Russ.)] doi. org/10.32000/2072-1757-2018-16-5-140-143.
17. Летникова К.Б., Ханджян А.Т., Оганесян О.Г. и др. Фемтосекундный кросслинкинг роговичного коллагена в лечении пациентов с прогрессирующим кератоконусом I-II стадии. Соврем. технол. мед. 2016;1: 128–33. [Letnikova KB, Khandjan AT, Oganesyan OG, et al. Femtosecond krosslinking corneal collagen in treatment of patients with progressive keratokonus stages I-II. Sovrem. tekhnol. med. 2016;1: 128–33. (In Russ.)] doi.org/10.17691/stm2016.8.1.17.
18. Паштаев Н.П., Поздеева Н.А., Зотов В.В. и др. Сравнительное исследование влияния фемтокросслинкинга на биомеханические свойства роговицы в эксперименте. Фундаментальные исследования. 2015;1: 1218–9. [Pashtaev NP, Pozdeeva NA, Zotov VV, et al. Comparative evaluation of different corneal cross linking techniques with respect to biomechanical stability of the cornea. Fundamentalnye issledovanya. 2015;1: 1218–9. (In Russ.)] doi.org/10.17116/ oftalma2016132238-46.
19. Dong Z, Zhou X. Collagen cross-linking with riboflavin in a femtosecond laser-created pocket in rabbit corneas: 6-month results. Am J. Ophthalmol. 2011;152: 22–7. doi.org/10.1016/j.ajo.2011.01.010.
20. Wollensak G, Hammer CM, Spor E, et al. Biomechanical efficacy of collagen crosslinking in porcine cornea using a femtosecond laser pocket. J. Cornea. 2014;33(3): 300–5. doi.org/10.1097/ ICO.0000000000000059.
Fyodorov Journal of Ophthalmic Surgery. 2020; : 14-17
Femtosecond laser VisuMax application for corneal collagen crosslinking
https://doi.org/10.25276/0235-4160-2020-1-14-17Abstract
Introduction. Corneal collagen crosslinking is a treatment method of advanced keratoconus, improving a «compaction» thickness or increasing a strength of corneal stroma. The high functional results and the shortened postoperative periods in patients during crosslinking using a femtosecond laser determine the prospects for a further study of this trend.
Purpose. To study the conditions and to apply the femtocrosslinking method based on the standard flap formation options using the VisuMax femtolaser device.
Material and methods. There were 20 patients under our observation with progressive keratoconus (20 eyes) who underwent femto cross-linking of corneal collagen using a VisuMax femto-laser. All patients were examined using the standard preoperative ophthalmologic methods (visometry, tonometry, keratorefractometry, pachymetry, keratotopography). The fact of progression of keratoconus was established on the basis of dynamic fellow-up for at least 6 months.
Results. Features of the method of femto-cross-linking of corneal collagen using the VisuMax are: 1) extension of the flap leg in the operating settings (the angular size of the bridge increased to 320°); 2) formation of the circular corneal pocket parallel to the front surface via the femto-laser and one arcuate corneal incision depth of 140–160 µm, and the diameter of the pocket and the arcuate cut – 7.9–8.7 mm.All patients (20 eyes, 100%) were achieved the stabilization of ecstatic process within the follow-up period of 6 and 12 months.
Conclusion. The conditions for the use of a laser installation VisuMax (Carl Zeiss) using the «FLAP» program in the operation of corneal collagen femtocroslinking have been determined. The advantage of this method is to simplify the classical way of doing cross-linking and increase its effectiveness. Promising is the further study of technology, dynamic control over patients and long-term results.
References
1. Mohammed Z, Allon B, Neda S et al. ASCRS Cornea Clinical Committee. Reshaping procedures for the surgical management of corneal ectasia. J. Cataract. Refract. Surg. 2015;41: 842–72. doi.org/10.1016/j. jcrs.2015.03.010.
2. Cresta FB, Cresta ML, Alves MR. Corneal collagen cross-linking. E-Oftalmo. CBO. 2017;3: 1–6. doi. org/10.17545/e-oftalmo.cbo/2017.92.
3. Wollensak G, Spoerl E, Seiler T. Riboflavin/ ultraviolet-a-inducedcollagen crosslinking for the treatment of keratoconus. Am J. Ophthalmol. 2003;135: 620–7. doi.org/10.1016/s0002-9394(02)02220-1.
4. Koller T, Pajic B, Vinciguerra P, et al. Flattening of the cornea after collagen crosslinking for keratoconus. J. Cataract. Refract. Surg. 2011;37: 1488–92. doi. org/10.1016/j.jcrs.2011.03.041.
5. Randleman JB, Khandelwal SS, Hafezi F. Corneal cross-linking. J. Surv. Ophthalmol. 2015;60: 509–23. doi. org/10.1016/j.survophthal.2015.04.002.
6. Vinciguerra P, Randleman JB, Romano V, et al. Transepithelialion to phoresis corneal collagen crosslinking for progressive keratoconus:initial clinical outcomes. J. Refract. Surg. 2014;30: 746–753. doi.org/ 10.3928/1081597X-20141021-06. 7.
7. Kohlhaas M, Spoerl E, Schilde T, et al. Biomechanical evidence of the distribution of crosslinks in corneas treated with riboflavin and ultraviolet a light. J. Cataract. Refract. Surg. 2006;32: 279–83. doi. org/10.1016/j.jcrs.2005.12.092.
8. Wollensak G, Spoerl E, Seiler T. Stress – strain measurements of human and porcine corneas after riboflavin-ultraviolet-A-induced cross-linking. J. Cataract. Refract. Surg. 2003;29(9): 1780–5.
9. Alhayek A, Lu PR. Corneal collagen crosslinking in keratoconus and other eye disease. Int. J. Ophthalmol. 2015;18: 407–18. doi.org/10.3980/j.issn.22223959.2015.02.35.
10. Raiskup F, Spoerl E. Corneal crosslinking with riboflavin and ultraviolet A. Part II. Clinical indications and results. J. Ocul. Surf. 2013; 11: 93–108. doi. org/10.1016/j.jtos.2013.01.003.
11. Vinciguerra P, Albe E, Trazza S, et al. Refractive, topographic, tomographic and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. J. Ophthalmology. 2009;116: 369–78. doi.org/10.1016/j. ophtha.2008.09.048.
12. Eljarrat-Binstock E, Domb AJ. Iontophoresis: a non-invasive ocular drug delivery. J. Control Release. 2006;110: 479–89. https://doi.org/10.1016/j. jconrel.2005.09.049
13. Leccisotti A, Islam T. Transepithelial corneal collagen cross-linking in keratoconus. J. Refract. Surg. 2010;26: 942–8. doi.org/10.3928/108159 7X-20100212-09.
14. Samaras K, O’Brart D, Doutch J, et al. Effect of epithelial retention and removal on riboflavin absorption in porcine corneas. J. Refract. Surg. 2009;25: 771–5. doi.org/10.3928/1081597X-20090813-03.
15. Sarkar J, Chaudhary S, Namavari A, et al. Corneal neurotoxicity due to topical benzalkonium chloride. J. Invest. Ophthalmol. Vis. Sci. 2012;53(4): 1792–802. doi. org/10.1167/iovs.11-8775.
16. Krasner K.Yu., Burilov K.B., Chernykh D.V. i dr. Refraktsionnaya operatsiya Relex Smile u patsienta posle tsirklyazha s miopicheskoi refraktsiei (klinicheskii sluchai). Prakticheskaya meditsina. 2018;16: 140–3. [Krasner KU, Burilov KB, Chernykh DV, et al. Relex Smile refractive operation in a patient after scleral buckle with myopic refraction (clinical case). Prakticheskaya medicina. 2018;16: 140–3. (In Russ.)] doi. org/10.32000/2072-1757-2018-16-5-140-143.
17. Letnikova K.B., Khandzhyan A.T., Oganesyan O.G. i dr. Femtosekundnyi krosslinking rogovichnogo kollagena v lechenii patsientov s progressiruyushchim keratokonusom I-II stadii. Sovrem. tekhnol. med. 2016;1: 128–33. [Letnikova KB, Khandjan AT, Oganesyan OG, et al. Femtosecond krosslinking corneal collagen in treatment of patients with progressive keratokonus stages I-II. Sovrem. tekhnol. med. 2016;1: 128–33. (In Russ.)] doi.org/10.17691/stm2016.8.1.17.
18. Pashtaev N.P., Pozdeeva N.A., Zotov V.V. i dr. Sravnitel'noe issledovanie vliyaniya femtokrosslinkinga na biomekhanicheskie svoistva rogovitsy v eksperimente. Fundamental'nye issledovaniya. 2015;1: 1218–9. [Pashtaev NP, Pozdeeva NA, Zotov VV, et al. Comparative evaluation of different corneal cross linking techniques with respect to biomechanical stability of the cornea. Fundamentalnye issledovanya. 2015;1: 1218–9. (In Russ.)] doi.org/10.17116/ oftalma2016132238-46.
19. Dong Z, Zhou X. Collagen cross-linking with riboflavin in a femtosecond laser-created pocket in rabbit corneas: 6-month results. Am J. Ophthalmol. 2011;152: 22–7. doi.org/10.1016/j.ajo.2011.01.010.
20. Wollensak G, Hammer CM, Spor E, et al. Biomechanical efficacy of collagen crosslinking in porcine cornea using a femtosecond laser pocket. J. Cornea. 2014;33(3): 300–5. doi.org/10.1097/ ICO.0000000000000059.
