圆锥角膜矫正术中Intacs植入术的良好与不良预后相关结果分析。
Analysis of results related to good and bad outcomes of Intacs implantation for keratoconus correction.
作者信息
Alió Jorge L, Shabayek Mohamed H, Belda José I, Correas Pablo, Feijoo Elio Diez
机构信息
Instituto Oftalmológico de Alicante, Vissum (Department of Cornea and Refractive Surgery), Miguel Hernández University, Medical School, Alicante, Spain.
出版信息
J Cataract Refract Surg. 2006 May;32(5):756-61. doi: 10.1016/j.jcrs.2006.02.012.
PURPOSE
To evaluate factors influencing good and poor outcomes after intracorneal ring segment implantation to correct keratoconus.
SETTING
Instituto Oftalmológico de Alicante (Vissum Corporation), University of Miguel Hernandez, Alicante, Spain.
METHODS
A retrospective comparative study of the visual outcome, 25 eyes of 21 patients were implanted after intracorneal ring segments (Intacs, Addition Technology) as a method to correct keratoconus. Outcomes were evaluated 6 months after implantation based on the visual results. Group A comprised 20 eyes that gained 3 lines or more of best spectacle-corrected visual acuity (BSCVA) to correct keratoconus, and Group B comprised 5 eyes that lost 1 line of BSCVA.
RESULTS
In Group A, the preoperative mean BSCVA was 0.43 (20/50) and the postoperative mean BSCVA, 0.82 (20/20) (P< or =.0001). In Group B, the preoperative mean BSCVA was 0.36 (20/63) and the postoperative mean BSCVA, 0.24 (20/80) (P< or =.02). The preoperative mean sphere power was 3.90 diopters (D) greater in Group B than in Group A (P< or =.007); the mean spherical equivalent was 4.36 D greater (P< or =.007), and the mean K-reading was 6.91 D greater (P< or =.001). The postoperative reduction in spherical dioptric power was 2.11 D (P< or =.027) and the mean spherical equivalent, 2.81 D (P< or =.003), significant only in Group A. The reduction in mean central K-readings was 4.30 D (P< or =.0001) in Group A and 6.19 D (P< or =.014) in Group B. The correlation of the preoperative mean K value to the postoperative BSCVA was significant at the .01 level by the Pearson test (-0.67). In Group A, all eyes (100%) had a mean K-reading < or =53 D. In Group B, 4 eyes (80%) had a mean K-reading > or =55 D.
CONCLUSION
Intacs provided better results in visual acuity and corneal topography quality and significantly reduced the spherical equivalent in eyes with keratoconus with relatively low mean K values (< or =53 D) and a relatively low spherical equivalent. In advanced keratoconus (mean K-reading > or =55 D), poor results can be anticipated.
目的
评估角膜内环植入术矫正圆锥角膜后影响预后良好或不良的因素。
机构
西班牙阿利坎特米格尔·埃尔南德斯大学阿利坎特眼科研究所（维苏姆公司）。
方法
一项关于视觉预后的回顾性对照研究，21例患者的25只眼接受了角膜内环（Intacs，Addition Technology公司）植入术以矫正圆锥角膜。根据术后6个月的视觉结果评估预后。A组包括20只眼，其最佳矫正视力（BSCVA）提高了3行或更多以矫正圆锥角膜，B组包括5只眼，其BSCVA下降了1行。
结果
A组术前平均BSCVA为0.43（20/50），术后平均BSCVA为0.82（20/20）（P≤0.0001）。B组术前平均BSCVA为0.36（20/63），术后平均BSCVA为0.24（20/80）（P≤0.02）。B组术前平均球镜度数比A组高3.90屈光度（D）（P≤0.007）；平均等效球镜度数高4.36 D（P≤0.007），平均角膜曲率读数高6.91 D（P≤0.001）。术后球镜度数降低2.11 D（P≤0.027），平均等效球镜度数降低2.81 D（P≤0.003），仅在A组有统计学意义。A组平均中央角膜曲率读数降低4.30 D（P≤0.0001），B组降低6.19 D（P≤0.014）。术前平均角膜曲率值与术后BSCVA的相关性经Pearson检验在α = 0.01水平有统计学意义（-0.67）。A组所有眼（100%）平均角膜曲率读数≤53 D。B组4只眼（80%）平均角膜曲率读数≥55 D。
结论
对于平均角膜曲率值相对较低（≤53 D）且等效球镜度数相对较低的圆锥角膜患者，Intacs在视力和角膜地形图质量方面提供了更好的结果，并显著降低了等效球镜度数。在晚期圆锥角膜（平均角膜曲率读数≥55 D）中，预后可能较差。
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