Офтальмохирургия. 2015; : 28-33
ОЦЕНКА РОЛИ КОНФОКАЛЬНОЙ МИКРОСКОПИИ В ОПРЕДЕЛЕНИИ ПРОТИВОПОКАЗАНИЙ К ЛАЗЕРНОЙ КОРРЕКЦИИ ПОСТКЕРАТОПЛАСТИЧЕСКОЙ АМЕТРОПИИ
https://doi.org/undefinedАннотация
РЕФЕРАТ
Цель. С помощью конфокальной микроскопии (КМ) изучить гистоморфологическое состояние посткератопластической роговицы и на основании полученных результатов определить противопоказания к лазерной коррекции индуцированных аметропий после сквозной кератопластики (СКП).
Материал и методы. Обследовано и прооперировано методом ЛАЗИК по стандартной технологии 38 глаз 38-ми пациентов после СКП с остаточной аметропией через 1-3 года после снятия роговичных швов и стабилизации послеоперационного кераторефракционного эффекта.
Результаты. Выявление по данным КМ низкой ПЭК (ниже 1000 кл/мм2) с полимегатизмом клеток более 50% и плеоморфизмом менее 50%, дистрофии боуменовой мембраны с нарушением адгезии базального эпителия, незавершенного рубцевания трансплантата, выраженной псевдокератинизации эпителия и отсутствия реиннервации после СКП является противопоказанием к проведению ЛАЗИК.
Вывод. КМ является необходимым методом неинвазивной оценки гистоморфологического состояния посткератопластической роговицы и прогнозирования исхода КРО.
Список литературы
1. Аветисов С.Э., Егорова Г.Б., Федоров А.А., Бобровских Н.В. Конфокальная микроскопия роговицы // Вестник офтальмологии. – 2008. – № 3. – С. 3-10.
2. Майчук Д.Ю. Принцип работы и клиническое применение конфокального микроскопа Confoscan 3 при дифференциальной диагностике заболеваний роговицы // Рефракционная хирургия и офтальмология. – 2004. – Т. 4, № 1. – С. 35-38.
3. Першин К.Б., Пашинова Н.Ф., Мийович О.П., Лихникевич Е.Н. LASIK у пациентов после имплантации ИОЛ и сквозных кератопластик // Съезд офтальмологов России, 7-й: Тез. докл. – М., 2000. – С. 279-280.
4. Amoozadeh J., Aliakbari S., Behesht-Nejad A.H. et al. Confocal microscopy of corneal stroma and endothelium after LASIK and PRK // J. Refract. Surg. – 2009. – Vol. 25. – Р. 963-967.
5. Bahar I., Kaiserman I., Mashor R.S. et al. Femtosecond LASIK combined with astigmatic keratotomy for the correction of refractive errors after penetrating keratoplasty // Ophthalmic Surg. Lasers Imaging. – 2010. – Vol. 41, № 2. – P. 242-249.
6. Barequet I.S., Hirsh A., Levinger S. Femtosecond thin-flap LASIK for the correction of ametropia after penetrating keratoplasty // J. Refract. Surg. – 2010. – Vol. 26, № 3. – P. 191-196.
7. Barreto J.Jr., Netto M.V., Reis A. et al. Topography-guided (NIDEK customized aspheric treatment zone) photorefractive keratectomy with mitomycin C after penetrating keratoplasty for keratoconus: case report // J. Refract. Surg. – 2009. – Vol. 25, № 1. – P. 131-135.
8. Bоhnke M., Masters B.R. Confocal microscopy of the cornea // Prog. Retin. Eye Res. – 1999. – Vol. 18. – P. 553-628.
9. Busin M., Zambianchi L., Garzione F. et al. Two-stage laser in situ keratomileusis to correct refractive errors after penetrating keratoplasty // J. Refract. Surg. – 2003. – Vol. 19, № 3. – P. 301-308.
10. Buzard K., Febbraro J.L., Fundingsland B.R. Laser in situ keratomileusis for the correction of residual ametropia after penetrating keratoplasty // J. Cataract Refract. Surg. – 2004. – Vol. 30, № 5. – P. 1006-1013.
11. Cavanagh D., Petroll M., Alizadeh H. et al. Clinical and diagnostic use of in vivo confocal microscopy in patients with corneal disease // Ophthalmology. – 1993. – Vol. 100, № 10. – Р. 1444-1453.
12. De la Paz M.F., Sibila G.R., Montenegro G. et al. Wedge resection for high astigmatism after penetrating keratoplasty for keratoconus: refractive and histopathologic changes // Cornea. – 2010. – Vol. 29, № 6. – P. 595-600.
13. Draca N., Covic A., Pauk M. et al. 1-year follow-up study of endothelial cell density loss after penetrating keratoplasty // Coll. Antropol. – 2011. – Vol. 35. – P. 11-14.
14. Lenhart P.D., Randleman J.B., Grossniklaus H.E., Stulting R.D. Confocal microscopic diagnosis of epithelial downgrowth // Cornea. – 2008. – Vol. 27, № 10. – Р. 1138-1141.
15. McLaren J.W., Bourne W.M., Patel S.V. Automated assessment of keratocyte density in stromal images from the ConfoScan 4 confocal microscope // Invest. Ophthalmol. Vis. Sci. – 2010. – Vol. 51, № 4. – Р. 1918-1926.
16. Patel S.V., Bourne W.M. Corneal endothelial cell loss 9 years after excimer laser keratorefractive surgery // Arch. Ophthalmol. – 2009. – Vol. 127, № 11. – Р. 1423-1427.
17. Savini G., Barboni P., Zanini M., Tseng S.C. Ocular surface changes in laser in situ keratomileusis-induced neurotrophic epitheliopathy // J. Refract. Surg. – 2004. – Vol. 20, № 6. – P. 803-809.
18. Sen H.N., Uusitalo R., Laatikainen L. Subclinical inflammation after laser in situ keratomileusis in corneal grafts // J. Cataract Refract. Surg. – 2002. – Vol. 28, № 5. – P. 782-787.
19. Stachs O., Zhivov A., Kraak R. et al. Structural-functional correlations of corneal innervation after LASIK and penetrating keratoplasty // J. Refract. Surg. – 2010. – Vol. 26, № 3. – P. 159-167.
20. Williams D.K, Bourne, David O. Hodge et al. Corneal endotelium five years after transplantation // Am. J. Ophthalmol. – 1994. – Vol. 118, № 2. – P.185-196.
21. Wilson S.E., Ambrоsio R. Laser in situ keratomileusis-induced neurotrophic epitheliopathy // Am. J. Ophthalmol. – 2001. – Vol. 132, № 3. – P. 405-406.
Fyodorov Journal of Ophthalmic Surgery. 2015; : 28-33
THE ROLE OF CONFOCAL MICROSCOPY IN DETERMINATION OF CONTRAINDICATIONS TO POSTKERATOPLASTIC AMETROPIA LASER CORRECTION
https://doi.org/undefinedAbstract
Purpose. To study the histomorphological state of the postkeratoplastic cornea using the confocal microscopy (CM) and based on the obtained results to determine contraindications to laser correction of induced ametropia after penetrating keratoplasty (PKP).
Material and methods. There were examined 38 eyes (38 patients) with residual ametropy after the penetrating keratoplasty (PKP) in pre- and post-keratorefractive surgery (standard LASIK) 1-3 years after the corneal sutures removal and the stabilization of the postoperative keratorefractive effect.
Results. Identification of the low DEC (below 1000cells/mm2) with cell polymegathism more than 50% and pleomorphism less than 50%, dystrophy of Bowman’s membrane with a impaired adhesion of basal epithelium, an incomplete graft scarring, the changed epithelial cytoarchitectonics, the absence of graft fibrosis in scar zone and post-PKP re-innervation are contraindications for the LASIK after PKP.
Сonclusion. The CM is a necessary method of the non-invasive evaluation of the histomorphological state of the post-PKP cornea and the prognosis of outcome for the laser correction after PKP.
References
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4. Amoozadeh J., Aliakbari S., Behesht-Nejad A.H. et al. Confocal microscopy of corneal stroma and endothelium after LASIK and PRK // J. Refract. Surg. – 2009. – Vol. 25. – R. 963-967.
5. Bahar I., Kaiserman I., Mashor R.S. et al. Femtosecond LASIK combined with astigmatic keratotomy for the correction of refractive errors after penetrating keratoplasty // Ophthalmic Surg. Lasers Imaging. – 2010. – Vol. 41, № 2. – P. 242-249.
6. Barequet I.S., Hirsh A., Levinger S. Femtosecond thin-flap LASIK for the correction of ametropia after penetrating keratoplasty // J. Refract. Surg. – 2010. – Vol. 26, № 3. – P. 191-196.
7. Barreto J.Jr., Netto M.V., Reis A. et al. Topography-guided (NIDEK customized aspheric treatment zone) photorefractive keratectomy with mitomycin C after penetrating keratoplasty for keratoconus: case report // J. Refract. Surg. – 2009. – Vol. 25, № 1. – P. 131-135.
8. Bohnke M., Masters B.R. Confocal microscopy of the cornea // Prog. Retin. Eye Res. – 1999. – Vol. 18. – P. 553-628.
9. Busin M., Zambianchi L., Garzione F. et al. Two-stage laser in situ keratomileusis to correct refractive errors after penetrating keratoplasty // J. Refract. Surg. – 2003. – Vol. 19, № 3. – P. 301-308.
10. Buzard K., Febbraro J.L., Fundingsland B.R. Laser in situ keratomileusis for the correction of residual ametropia after penetrating keratoplasty // J. Cataract Refract. Surg. – 2004. – Vol. 30, № 5. – P. 1006-1013.
11. Cavanagh D., Petroll M., Alizadeh H. et al. Clinical and diagnostic use of in vivo confocal microscopy in patients with corneal disease // Ophthalmology. – 1993. – Vol. 100, № 10. – R. 1444-1453.
12. De la Paz M.F., Sibila G.R., Montenegro G. et al. Wedge resection for high astigmatism after penetrating keratoplasty for keratoconus: refractive and histopathologic changes // Cornea. – 2010. – Vol. 29, № 6. – P. 595-600.
13. Draca N., Covic A., Pauk M. et al. 1-year follow-up study of endothelial cell density loss after penetrating keratoplasty // Coll. Antropol. – 2011. – Vol. 35. – P. 11-14.
14. Lenhart P.D., Randleman J.B., Grossniklaus H.E., Stulting R.D. Confocal microscopic diagnosis of epithelial downgrowth // Cornea. – 2008. – Vol. 27, № 10. – R. 1138-1141.
15. McLaren J.W., Bourne W.M., Patel S.V. Automated assessment of keratocyte density in stromal images from the ConfoScan 4 confocal microscope // Invest. Ophthalmol. Vis. Sci. – 2010. – Vol. 51, № 4. – R. 1918-1926.
16. Patel S.V., Bourne W.M. Corneal endothelial cell loss 9 years after excimer laser keratorefractive surgery // Arch. Ophthalmol. – 2009. – Vol. 127, № 11. – R. 1423-1427.
17. Savini G., Barboni P., Zanini M., Tseng S.C. Ocular surface changes in laser in situ keratomileusis-induced neurotrophic epitheliopathy // J. Refract. Surg. – 2004. – Vol. 20, № 6. – P. 803-809.
18. Sen H.N., Uusitalo R., Laatikainen L. Subclinical inflammation after laser in situ keratomileusis in corneal grafts // J. Cataract Refract. Surg. – 2002. – Vol. 28, № 5. – P. 782-787.
19. Stachs O., Zhivov A., Kraak R. et al. Structural-functional correlations of corneal innervation after LASIK and penetrating keratoplasty // J. Refract. Surg. – 2010. – Vol. 26, № 3. – P. 159-167.
20. Williams D.K, Bourne, David O. Hodge et al. Corneal endotelium five years after transplantation // Am. J. Ophthalmol. – 1994. – Vol. 118, № 2. – P.185-196.
21. Wilson S.E., Ambrosio R. Laser in situ keratomileusis-induced neurotrophic epitheliopathy // Am. J. Ophthalmol. – 2001. – Vol. 132, № 3. – P. 405-406.
