Piñero David P, Alio Jorge L, El Kady Bassam, Coskunseven Efekan, Morbelli Hector, Uceda-Montanes Antonio, Maldonado Miguel J, Cuevas Diego, Pascual Inmaculada
Vissum/Instituto Oftalmológico de Alicante, Spain.
Ophthalmology. 2009 Sep;116(9):1675-87. doi: 10.1016/j.ophtha.2009.05.016. Epub 2009 Jul 29.
To compare visual, refractive, and corneal aberrometric outcomes in keratoconic eyes implanted with intracorneal ring segments (ICRS) implantation using either a mechanical or a femtosecond laser-assisted procedure.
Retrospective, consecutive case series.
A total of 146 consecutive eyes of 106 patients with the diagnosis of keratoconus (68 unilateral and 39 bilateral) were included. Two groups were created according to the surgical technique used for corneal tunnelization: Mechanical group (mechanical tunnelization, 63 eyes) and Femtosecond group (femtosecond laser-assisted tunnelization, 83 eyes). Intracorneal ring segments implantation was indicated because of the existence of reduced best spectacle-corrected visual acuity (BSCVA) or contact lens intolerance.
Intracorneal ring segments implantations were performed by 6 surgeons following the same protocol except for the incision location. A total of 55 eyes were implanted with Intacs (Addition Technology, Inc, Fremont, CA) and 8 eyes were implanted with KeraRings (Mediphacos, Belo Horizonte, Brazil) in the Mechanical group, and 25 eyes were implanted with Intacs and 58 eyes were implanted with KeraRings in the Femtosecond group. Mean follow-up was 10.66+/-8.20 months, ranging from 1 month to 24 months.
Uncorrected visual acuity (UCVA), BSCVA, refraction, keratometry, and root mean square (RMS) for different kinds of corneal aberrations.
By reporting only for statistically significant changes, UCVA improved in both groups at 6 months (P< or =0.02) and BSCVA improved in the Femtosecond group (P<0.01). The refraction improved in both groups at 6 months (P< or =0.02). The cornea on average was flatter in both groups at 6 months (P<0.01). Root mean square astigmatism was reduced in the Femtosecond group (P = 0.03), but there was an increase in some higher-order aberrations (P = 0.03). Significant differences were found between the 2 groups for eyes implanted with Intacs for primary spherical aberration, coma, and other higher-order aberrations, favoring the Femtosecond group (P< or =0.01). A significant negative correlation was found between the preoperative corneal aberrations and the postoperative BSCVA in the Mechanical group (r>0.63, P< or =0.04).
Intracorneal ring segments implantation using both mechanical and femtosecond laser-assisted procedures provide similar visual and refractive outcomes. A more limited aberrometric correction is observed for eyes with mechanical implantation.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
比较采用机械法或飞秒激光辅助法植入角膜环片（ICRS）的圆锥角膜患者的视力、屈光及角膜像差结果。
回顾性连续病例系列。
共纳入106例诊断为圆锥角膜的患者的146只连续患眼（68例单眼，39例双眼）。根据用于角膜隧道制作的手术技术分为两组：机械组（机械隧道制作，63只眼）和飞秒组（飞秒激光辅助隧道制作，83只眼）。因最佳矫正视力（BSCVA）降低或不耐受隐形眼镜而进行角膜环片植入。
6名外科医生按照相同方案进行角膜环片植入，除切口位置外。机械组中，55只眼植入Intacs（Addition Technology, Inc, Fremont, CA），8只眼植入KeraRings（Mediphacos, Belo Horizonte, Brazil）；飞秒组中，25只眼植入Intacs，58只眼植入KeraRings。平均随访时间为10.66±8.20个月，范围从1个月至24个月。
不同类型角膜像差的裸眼视力（UCVA）、BSCVA、屈光、角膜曲率及均方根（RMS）。
仅报告具有统计学意义的变化，两组在6个月时UCVA均改善（P≤0.02），飞秒组BSCVA改善（P<0.01）。两组在6个月时屈光均改善（P≤0.02）。两组在6个月时角膜平均变平（P<0.01）。飞秒组均方根散光降低（P = 0.03），但一些高阶像差增加（P = 0.03）。对于植入Intacs的眼，两组在原发性球差、彗差及其他高阶像差方面存在显著差异，飞秒组更优（P≤0.01）。机械组术前角膜像差与术后BSCVA之间存在显著负相关（r>0.63，P≤0.04）。
采用机械法和飞秒激光辅助法植入角膜环片可提供相似的视力和屈光结果。机械植入的眼观察到像差矫正更有限。
作者对本文讨论的任何材料均无所有权或商业利益。
