Piñero David P, Alio Jorge L, Morbelli Hector, Uceda-Montanes Antonio, El Kady Bassam, Coskunseven Efekan, Pascual Inmaculada
Vissum/Instituto Oftalmológico de Alicante, Spain.
Ophthalmology. 2009 Sep;116(9):1656-64. doi: 10.1016/j.ophtha.2009.06.002. Epub 2009 Jul 29.
To evaluate refractive, visual, and aberrometric changes in corneas with pellucid marginal degeneration (PMD) implanted with intracorneal ring segments (ICRS) during a 6-month follow-up.
Retrospective, consecutive case series.
We included 21 consecutive eyes of 15 patients ranging in age from 21 to 73 years old and with a diagnosis of PMD. This diagnosis was made on the basis of slit-lamp (inferior corneal thinning), corneal topography ("butterfly" pattern), and refractive findings (significant against-the-rule astigmatism with best spectacle-corrected visual acuity loss).
A multicenter, retrospective analysis of patients undergoing ICRS implantation for the management of PMD in 4 ophthalmologic centers was performed. Surgery was indicated in all cases because of reduced best spectacle-corrected visual acuity (BSCVA) and/or contact lens intolerance or dissatisfaction. Mechanical corneal tunnelization was performed in 7 eyes and femtosecond laser-assisted tunnelization in 14 eyes. Intacs were implanted in only 3 eyes whereas KeraRings in 18 eyes. Refractive and corneal aberrometric changes were analyzed during a 6-month follow-up.
Uncorrected corrected visual acuity (UCVA) and BSCVA, refraction, keratometry, and root mean square (RMS) for different kinds of corneal aberrations.
The UCVA did not improve at 6 months after surgery (P = 0.11). The BSCVA increased from a mean preoperative value of 0.54 to a mean postoperative value of 0.75 (P = 0.06). At 6 months, 44.44% of eyes gained > or =2 lines of BSCVA. Sphere (P = 0.02), cylinder (P<0.01), and spherical equivalent (P<0.01) were reduced significantly after surgery (P< or =0.02). Mean keratometry decreased significantly from 44.95 diopters (D) preoperatively to 43.19 D at 6 months postoperatively (P<0.01). The RMS values for astigmatism, higher order residual, and coma-like aberrations were significantly reduced with surgery (P = 0.03). In addition, significant negative correlations of preoperative RMS astigmatism (r = -0.90) and primary spherical aberration (r = -0.86) with postoperative BSCVA were also found. Segment ring explantation was performed in a total of 4 eyes owing to poor visual outcome.
Implantation of an ICRS is an effective option for the treatment of 2nd-order and higher aberrations in corneas with PMD. Preoperative corneal astigmatism and spherical aberration seem to be limiting factors for a good visual outcome.
FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this manuscript.
评估在6个月的随访期内，接受角膜内环植入术（ICRS）的透明边缘变性（PMD）角膜的屈光、视觉和像差变化。
回顾性连续病例系列。
我们纳入了15例年龄在21至73岁之间、诊断为PMD的患者的21只连续眼睛。该诊断基于裂隙灯检查（角膜下方变薄）、角膜地形图（“蝴蝶”图案）以及屈光检查结果（显著的逆规散光且最佳矫正视力下降）。
对4个眼科中心接受ICRS植入术治疗PMD的患者进行多中心回顾性分析。所有病例均因最佳矫正视力（BSCVA）降低和/或佩戴隐形眼镜不耐受或不满意而进行手术。7只眼睛采用机械角膜隧道化，14只眼睛采用飞秒激光辅助隧道化。仅3只眼睛植入了Intacs，18只眼睛植入了KeraRings。在6个月的随访期内分析屈光和角膜像差变化。
不同类型角膜像差的未矫正视力（UCVA）和BSCVA、屈光、角膜曲率测量以及均方根（RMS）。
术后6个月UCVA未改善（P = 0.11）。BSCVA从术前平均0.54提高到术后平均0.75（P = 0.06）。6个月时，44.44%的眼睛BSCVA提高了≥2行。术后球镜度（P = 0.02）、柱镜度（P<0.01）和等效球镜度（P<0.01）显著降低（P≤0.02）。角膜平均曲率术前为44.95屈光度（D），术后6个月显著降至43.19 D（P<0.01）。手术使散光、高阶残余像差和类彗差的RMS值显著降低（P = 0.03）。此外，还发现术前RMS散光（r = -0.90）和初级球差（r = -0.86）与术后BSCVA存在显著负相关。共有4只眼睛因视力不佳进行了节段环取出术。
植入ICRS是治疗PMD角膜二阶及更高阶像差的有效选择。术前角膜散光和球差似乎是良好视觉效果的限制因素。
作者对本稿件中讨论的任何材料均无专利或商业利益。
