Department of Opthalmology, Medical University Innsbruck and Eye Center Ybbs-Linz, Ybbs, Austria.
J Refract Surg. 2010 Mar;26(3):217-21. doi: 10.3928/1081597X-20100224-08. Epub 2010 Mar 11.
No theory or method currently exists to preoperatively predict the optimal position of an intracorneal implant for the treatment of keratoconus, or a surgical system or technique to adjust and optimize the position of the implant after its implantation. A surgical technique for adjusting the position of the implant inside the cornea is presented, and by adjusting the position of the implant after its insertion into a corneal pocket, the surgical results in keratoconus treatment may be improved.
After the formation of a closed pocket of 9 mm in diameter and 300 mum in depth within the corneal stroma, a flexible full-ring implant is inserted into the corneal pocket via a narrow incision tunnel. After insertion and evaluation of the clinical data, the implant position can be adjusted inside the pocket to achieve an optimal treatment result.
The procedure is quick and easy to perform. An adjustment of the implant position of only 0.5 mm towards the apex of the cone may dramatically improve the surgical result.
The presented technique enables the surgeon to access all three degrees of freedom possible in theory, which are associated with intracorneal implants in a corneal stroma, including implant diameter, implant thickness, and implant position. This is of particular importance for the treatment of irregularly shaped corneas such as in keratoconus.
目前尚无理论或方法可用于术前预测治疗圆锥角膜的角膜内植入物的最佳位置，也没有用于调整和优化植入物位置的手术系统或技术。本文提出了一种调整角膜内植入物位置的手术技术，通过调整植入角膜囊后的植入物位置，可以改善圆锥角膜治疗的手术效果。
在角膜基质内形成直径为 9 毫米、深度为 300 微米的封闭袋后，通过一个狭窄的切口隧道将柔性全环植入物插入角膜袋中。插入后评估临床数据，可在囊内调整植入物位置以达到最佳治疗效果。
该过程快速且易于操作。植入物位置只需向圆锥顶点方向调整 0.5 毫米，就可能显著改善手术效果。
本文提出的技术使外科医生能够获得理论上与角膜基质内角膜内植入物相关的所有三个自由度，包括植入物直径、植入物厚度和植入物位置。对于治疗不规则形状的角膜（如圆锥角膜），这一点尤为重要。
