Shabayek Mohamed H, Alió Jorge L
Vissum Instituto Oftalmológico de Alicante/Department of Cornea and Refractive Surgery and Division of Ophthalmology, Miguel Hernández University Medical School, Alicante, Spain.
Ophthalmology. 2007 Sep;114(9):1643-52. doi: 10.1016/j.ophtha.2006.11.033. Epub 2007 Apr 2.
To report the outcomes after the implantation of intrastromal corneal ring segments (KERARING) aided by femtosecond laser for the correction of keratoconus.
Prospective consecutive interventional study.
Twenty-one eyes of 16 consecutive keratoconic patients with mean age 32+/-10.2 years. Forty-five percent were keratoconus grade I, 20% grade II, 15% grade III, and 20% grade IV.
Intrastromal corneal ring segments KERARING were implanted for keratoconus correction after corneal tunnel creation with the aid of femtosecond laser (IntraLase Corp, Irvine CA).
Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive outcome, complete ophthalmologic examination, videokeratography, and corneal higher order aberrations (HOA) were determined or performed before and after surgery at 1 day, 1 week, and 3 and 6 months. In addition, operative and postoperative complications were recorded.
KERARING implantation significantly increased UCVA from 0.06 to 0.3 (P< or =0.0001), BSCVA from 0.54 to 0.71 (P< or =0.0003), and decreased the spherical equivalent by 2.28 diopters (D) and the average keratometric values (K value) by 2.24 D (P<0.001). There was no significant difference between the 3 and 6 months follow-up. Forty percent (8 eyes with a relatively low RMS of total HOA) showed a nonsignificant increase in the RMS of total HOA and 60% (12 eyes with a relatively higher RMS of total HOA> or =3.0 microm) showed significant (P< or =0.01) decrease in the RMS of total HOA due to a significant (P< or =0.003) reduction in coma and comalike aberrations. The amount of change in corneal curvature (biomechanical response) ranged from a decrease of 18% from its initial value to an increase of 2.75% and was not correlated to any preoperative parameter. Localized infectious keratitis occurred in only 1 eye (4.8%), and incision opacification occurred in 8 eyes (38%).
Intrastromal corneal ring segment implantation with femtosecond laser is an effective method for correcting keratoconus with reduction in corneal HOA in eyes with coma aberration > 3.0 microm.
报告飞秒激光辅助下基质内角膜环片（KERARING）植入治疗圆锥角膜的效果。
前瞻性连续干预性研究。
16例连续圆锥角膜患者的21只眼，平均年龄32±10.2岁。45%为I级圆锥角膜，20%为II级，15%为III级，20%为IV级。
在飞秒激光（IntraLase公司，加利福尼亚州欧文市）辅助下制作角膜隧道后，植入基质内角膜环片KERARING以矫正圆锥角膜。
在术后1天、1周、3个月和6个月测定或进行术前及术后的裸眼视力（UCVA）、最佳矫正视力（BSCVA）、屈光结果、完整的眼科检查、角膜地形图检查以及角膜高阶像差（HOA）。此外，记录手术及术后并发症。
KERARING植入显著提高UCVA，从0.06提高到0.3（P≤0.0001），BSCVA从0.54提高到0.71（P≤0.0003），等效球镜度降低2.28屈光度（D），平均角膜曲率值（K值）降低2.24 D（P<0.001）。3个月和6个月随访之间无显著差异。40%（8只眼总HOA的均方根相对较低）总HOA的均方根无显著增加，60%（12只眼总HOA的均方根相对较高≥3.0微米）总HOA的均方根显著降低（P≤0.01），这是由于彗差和类彗差显著降低（P≤0.003）。角膜曲率的变化量（生物力学反应）范围为从初始值降低18%到增加2.75%，且与任何术前参数均无相关性。仅1只眼（4.8%）发生局限性感染性角膜炎，8只眼（38%）出现切口混浊。
飞秒激光辅助下基质内角膜环片植入是矫正圆锥角膜的有效方法，对于彗差像差>3.0微米的眼可降低角膜HOA。
