| Objective: To explore the early safety and efficacy of femtosecond laserassisted intrastromal lenticular implantation(FILI)in correcting hyperopia.Methods: A prospective study was conducted.Seven patients(9 eyes)with moderate and high hyperopia who met the surgical requirements were enrolled in the Affiliated Eye Hospital of Nanchang University from March 2018 to September2019.Four of them were males(6 eyes)and three were females(3 eyes),aged from18 to 28 years with an average age of(20.50±3.89)years.FILI was performed on their cornea.UDVA,UNVA,BCDVA,SE,corneal curvature,corneal general condition and nerve growth,etc.were observed in 1 day,1 week,1 month,3 months and 6 months after operation.The statistic P < 0.05 was set as statistical significance by repeated measurement of one-way ANOVA.Donor corneas were from myopic patients who underwent small incision lenticule extraction(SMILE)at the same time.All of them were healthy.No abnormalities were found in preoperative tests.There was no history of chronic diseases and eye surgery on they.Result: All cases were operated successfully.Corneal rejection occurred in only one case(1 eye)at 4 months after operation.No complications such as keratitis or epithelial implantation occurred.All patients indicated that the visual acuity was improved and the feeling of visual fatigue was significantly relieved,corneal stromal edema disappeared in 1 month post-operation,and the boundary of lenticules could not be recognized in 6 months after operation.The UNVA was improved at all time points after operation(P < 0.05).At the last follow-up,UDVA in 1 eye(11.1%)increased 4 lines than pre-operation,5 eyes(55.6%)increased 1 line than pre-operation,1 eye(11.1%)was equal to post-operation,and 1 eye(11.1%)reduced2 lines than pre-operation.The SE after operation was significantly improved compared with pre-operation(P < 0.001),and slightly overcorrected after operation at each follow-up time.There was no significant difference in SE and UNVA between 1day post-operation and 6 months post-operation(P > 0.05).Postoperative BCDVA was not satisfied in 2 eyes.After lenticules replacement,all eyes reached preoperativelevel.The BCDVA in the other eyes reached the pre-operative level.The K1,K2 and CCT of the anterior corneal surface increased significantly at all time points after operation(P < 0.001).There was no significant difference in Km of the posterior corneal surface between pre-operation and post-operation(P > 0.05).The OCT(except for 1 eye with rejection)showed smooth corneal surface,transparent and well-located lenticules without wrinkles and rejection,and blurred boundary of lenticules at 6 months after surgery.The confocal examination showed corneal edema and hyperreflex at the boundary of lenticules at the first week after operation,with scattered irregular small particles,disordered lenticules structure,and activated corneal stromal cells in both lenticules tissue and corneal stromal layer.At the first month after operation,corneal edema subsided,hyperreflex at the boundary of lenticules was lighter than before,and stromal cells were still in an active state,and high reflective small particles and nerve fibers can be seen,the structure of lenticules was more regular than before.The nucleus of stromal cells were slender and the number of activated corneal stromal cells in corneal stroma layer were less than before.Six months after operation,the boundary of lenticules basically returns to normal,the number of highly reflective small particles were significantly reduced,the stromal cells were stationary,the nerve fibers were thinner than before,the structure of lenticules were more regular,the morphology of most of the stromal cell nucleus and corneal stromal layer returned to normal,stromal cells were stationary.Conclusion: The FILI is safe and effective in the early stage in correction of hyperopia,but the predictability needs to be improved,and the long-term effect needs further follow-up observation. |
PDF Full Text Request