目的：研究异体角膜基质透镜植入联合角膜胶原交联术治疗中晚期圆锥角膜的安全性及有效性。

方法：回顾性病例分析。纳入2021年6月至2023年12月于济南明水眼科医院行同种异体角膜基质透镜[来源于同一天行飞秒激光微小切口基质透镜取出术(SMILE)手术的近视患者的角膜基质透镜作为供体]植入联合角膜胶原交联术治疗的中晚期圆锥角膜患者19例20眼。比较术前，术后1 wk，1、3、6 mo裸眼远视力(UCVA)、角膜最薄点厚度、角膜中央区上皮厚度、角膜前表面平坦曲率(Kf)、陡峭曲率(Ks)、平均角膜曲率(Km)及角膜生物力学指标[第一次压平时间(A1T)、第一次压平长度(A1L)、第一次压平速度(VIN)、第二次压平时间(A2T)、第二次压平长度(A2L)、第二次压平速度(VOUT)、最大压陷时间(HCT)、最大压陷角膜曲率半径(HCR)、两峰间距(PD)、压陷深度(DA)、角膜第一次形状改变/压平状态时的硬度参数(SP-A1)、综合半径指数(IR)、角膜中央点厚度(CCT)、眼内压力(IOP)及矫正角膜厚度、生物力学参数后的眼内压(bIOP)及角膜厚度变异率(ARTH)]。

结果：所有患者均顺利完成手术，术中均未发生并发症。纳入患者手术前后UCVA、角膜生物力学参数A1L、A2L、PD、A1T、A2T、VIN、VOUT、DA、IOP、bIOP比较均无差异(均P>0.05)； 手术前后角膜最薄点厚度、角膜中央上皮厚度、Kf、Ks、Km、角膜生物力学参数HCT、HCR、SP-A1、ARTH、IR、CCT比较均有差异(均P<0.05)。角膜前表面曲率在术后呈现先增加后下降的趋势。术后HCT、HCR、SP-A1、ARTH、IR、CCT与术前比较均有差异(均P<0.005)。

结论：异体角膜基质透镜植入联合角膜胶原交联术治疗中晚期圆锥角膜具有良好的安全性与稳定性，可增加角膜厚度及角膜硬度，术后角膜不易发生形变。

METHODS: A retrospective case series analysis was conducted. A total of 19 patients(20 eyes)with moderate to advanced keratoconus who underwent combined allogeneic intrastromal lenticule implantation and CXL at the Jinan Mingshui Eye Hospital from June 2021 to December 2023 were included. The uncorrected distance visual acuity(UCVA), thinnest corneal thickness, central corneal epithelial thickness, anterior corneal flat keratometry(Kf), steep keratometry(Ks), and mean keratometry(Km), as well as the first applanation time(A1T), the first applanation length(A1L), the velocity during the first applanation moment(VIN), the second applanation time(A2T), the second applanation length(A2L), the velocity during the second applanation moment(VOUT), highest concavity time(HCT), highest concavity radius(HCR), peak distance(PD), deformation amplitude(DA), stiffness parameter at first applanation(SP-A1), integrated radius(IR), central corneal thickness(CCT), intraocular pressure(IOP), corneal thickness-corrected IOP, biomechanically intraocular pressure IOP(bIOP), and corneal thickness variation rate(ARTH)were compared between the two groups before surgery and at 1 wk, 1, 3 and 6 mo after surgery.

RESULTS: All patients successfully completed the surgery without any intraoperative complications. No significant differences were observed between pre-operative and post-operative measurements for UCVA or the corneal biomechanical parameters, including A1L, A2L, PD, A1T, A2T, VIN, VOUT, DA, IOP, and bIOP(all P>0.05). Significant differences were found between pre-operative and post-operative values for corneal thinnest point thickness, central corneal epithelial thickness, Kf, Ks, Km, and the corneal biomechanical parameters, including HCT, HCR, SP-A1, ARTH, IR, and CCT(all P<0.05). The anterior corneal curvature demonstrated an initial increase followed by a decrease post-operatively. Furthermore, significant differences were observed between pre-operative and post-operative values for HCT, HCR, SP-A1, ARTH, IR, and CCT(all P<0.005).

CONCLUSION: Allogenic intrastromal lenticule implantation combined with corneal collagen cross-linking demonstrates favorable safety and stability in treating moderate-to-advanced keratoconus. This combined procedure effectively increases corneal thickness and rigidity, resulting in corneas that are more resistant to deformation postoperatively.