定制基质增强术后角膜炎的生物力学变化

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-02-20 DOI:10.4103/tjo.tjo-d-23-00155

Sana Niazi, J. A. D. del Barrio, Farideh Doroodgar, Azad Sanginabadi, C. Alinia, S. J. Hashemian, Hassan Hashemi, Jorge L. Alió

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引用次数: 0

摘要

为了验证角膜生物力学的变化，通过 Corvis ST（Oculus，德国韦茨拉尔）使用近视小切口角膜瓣摘除术（SMILEs）角膜瓣对晚期角膜病（KCN）患者进行了角膜基质增强术。一项临床试验招募了 22 名晚期 KCN 患者。我们根据提名图植入了超过 100 μ 的透镜，并通过 Corvis ST 评估了植入后 3 个月、6 个月和 24 个月的生物力学因素。我们检查了第一次瞳孔散大（A1）、第二次瞳孔散大（A2）、最高凹（HC）/最大凹事件期间的参数以及文琪奎拉筛查参数，这些都是最近建立的标准，这些标准来自于各种生物力学和眼部因素的理想融合，并通过应用逻辑回归进行了制定。回归分析探讨了与年龄、平均角膜测量值、厚度、球面、柱面和最佳矫正视力之间的关系。患者的年龄、眼压和中央角膜厚度（CCT）都非常匹配。平均球面等效视力从-13.48 ± 2.86屈光度（D）下降到-8.59 ± 2.17屈光度（P < 0.007），平均角膜曲率从54.68 ± 2.77屈光度下降到51.95 ± 2.21屈光度（P < 0.006）。HC时间（HCT）、HC状态下的半径-中心曲率半径、HC状态下的峰值距离（PD）、CCT、首次角膜塑形时间和硬度参数（A1T和SP-A1）均有显著增加，而HC变形幅度、HC状态下的半径-中心曲率半径、HC状态下的峰值距离（PD）、CCT、首次角膜塑形时间和硬度参数（A1T和SP-A1）均有显著增加、而 HC 变形幅度、2 毫米处最大变形幅度比、Corvis 生物力学指数（CBI）、综合半径（IR）、第二次瞳孔散大变形幅度（A2DA）、第一次瞳孔散大速度和偏转幅度（A1V 和 A1DeflA）在支架植入后明显下降。多变量回归显示，年龄与 SP-A1 呈正相关（P = 0.003），与 HC 三角弧长度呈负相关（P = 0.007）。平均 K 值与 CCT 呈正相关（P = 0.05），与 CBI 呈负相关（P = 0.032）。最佳矫正视力与 HCT 呈正相关（P = 0.044），柱状体与 PD（P = 0.05）和 CCT（P = 0.05）呈正相关，而与 IR 呈负相关（P = 0.025）。使用近视SMILE透镜进行基质增量可引起KCN角膜生物力学的显著变化。

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Biomechanical changes in keratoconus after customized stromal augmentation

To verify corneal biomechanical changes, poststromal augmentation using myopic small-incision lenticule extraction’s (SMILEs) lenticules in advanced keratoconus (KCN) through Corvis ST (Oculus, Wetzlar, Germany). A clinical trial enrolled 22 advanced KCN patients. We implanted lenticules exceeding 100 μ according to a nomogram and evaluated biomechanical factors through Corvis ST at 3-, 6-, and 24-month postimplantation. We examined parameters during the first applanation (A1), second applanation (A2), highest concavity (HC)/max concavity events, and Vinciguerra screening parameters, as recently established criteria derived from the ideal blend of diverse biomechanical and ocular factors and formulated through the application of logistic regression. Regression analyses explored relationships with age, mean keratometry value, thickness, sphere, cylinder, and best-corrected visual acuity. Patients were well matched for age, intraocular pressure, and central corneal thickness (CCT). The mean spherical equivalent decreased from −13.48 ± 2.86 Diopters (D) to −8.59 ± 2.17 D (P < 0.007), and mean keratometry decreased from 54.68 ± 2.77 D to 51.95 ± 2.21 D (P < 0.006). Significant increases were observed in HC time (HCT), Radius–central curvature radius at the HC state–, peak distance (PD) during HC state, CCT, first applanation time, and stiffness parameter (A1T and SP-A1), whereas HC deformation amplitude, maximum deformation amplitude ratio at 2 mm, Corvis Biomechanical Index (CBI), integrated radius (IR), second applanation deformation amplitude (A2DA), first applanation velocity and deflection amplitude (A1V and A1DeflA) significantly decreased postlenticule implantation. Multivariable regression revealed age positively correlated with SP-A1 (P = 0.003) and negatively with HC delta Arc length (P = 0.007). Mean K positively correlated with CCT (P = 0.05) and negatively with CBI (P = 0.032). Best-corrected visual acuity positively correlated with HCT (P = 0.044), and the cylinder positively correlated with PD (P = 0.05) and CCT (P = 0.05) whereas negatively with IR (P = 0.025). Stromal augmentation using myopic SMILE lenticules induces significant corneal biomechanical changes in KCN.

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.