Pacific Laser Eye Centre, 1401 W Broadway, Fifth Fl, Vancouver BC, Canada V6H 1H6.
J Refract Surg. 2012 Nov;28(11 Suppl):S841-8. doi: 10.3928/1081597X-20121005-06.
To report results of a series of highly aberrated corneas treated with a topography-guided excimer laser ablation.
Retrospective, nonrandomized, consecutive series of eyes treated with topography-guided photorefractive keratectomy (TG-PRK) with the customized topographical neutralization technique (TNT). Cases included postoperative refractive surgery decentered ablations, optical zone enlargement, asymmetrical astigmatism, postoperative radial keratotomy (RK), postoperative keratoplasty, keratoconus combined with collagen cross-linking (CXL), and postoperative LASIK ectasia combined with CXL. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction were analyzed preoperatively and 6 months postoperatively.
In decentered ablation cases, 94% of 37 eyes were within 1.00 diopter (D) of the attempted refractive outcome, with 76% within 0.50 D. Mean topographic, central, optical zone of uniform (monodioptric) power increased from 3.5 to 5.2 mm in 25 eyes. Thirty-one eyes treated for asymmetrical astigmatism showed improvement in cylinder from mean 1.31 to 0.52 D. Ten of 11 eyes treated for previous RK astigmatism achieved postoperative UDVA 20/40 or better. Twenty-seven eyes with postoperative keratoplasty astigmatism were treated, with 7 (25.9%) eyes gaining > or = 2 lines and 12 (44.4%) eyes gaining > or = 1 line of CDVA. Of eyes with keratoconus that were treated using TG-PRK with CXL, 42 (58%) eyes had UDVA 20/40 or better, and 66 (92%) eyes had CDVA 20/40 or better. Twelve (71%) of 17 eyes treated for postoperative LASIK ectasia using TG-PRK with CXL had UDVA 20/40 or better. Nine (53%) eyes gained > or = 2 lines of CDVA.
Topography-guided laser treatment with custom TNT, combined with CXL in keratoconus and ectasia, is an effective, safe, and increasingly predictable option for highly aberrated corneas.
报告一系列经高度像差角膜行激光光折射术治疗的结果。
回顾性、非随机、连续系列行基于地形图引导的光折射性角膜切削术（TG-PRK）并采用定制化的地形图中性化技术（TNT）治疗的病例。病例包括术后屈光手术偏心消融术、光学区扩大、不对称性散光、术后放射状角膜切开术（RK）、术后角膜移植、圆锥角膜联合胶原交联（CXL）以及术后 LASIK 扩张联合 CXL。分析术前和术后 6 个月的未矫正距离视力（UDVA）、矫正距离视力（CDVA）和显微微镜验光。
在偏心消融病例中，37 只眼中的 94%达到了预期屈光结果的 1.00 屈光度（D）以内，76%达到了 0.50 D 以内。25 只眼中，平均地形图、中央、光学区均匀（单光）功率从 3.5 毫米增加到 5.2 毫米。31 只治疗不对称性散光的眼中，平均柱镜从 1.31 减少到 0.52 D。11 只治疗先前 RK 散光的眼中，术后 UDVA 20/40 或以上者有 10 只。27 只治疗术后角膜移植散光的眼中，有 7 只（25.9%）增加了 >或= 2 行，12 只（44.4%）增加了 >或= 1 行 CDVA。经 TG-PRK 联合 CXL 治疗的圆锥角膜眼中，42 只（58%）达到了 UDVA 20/40 或以上，66 只（92%）达到了 CDVA 20/40 或以上。17 只经 TG-PRK 联合 CXL 治疗的术后 LASIK 扩张眼中，有 12 只（71%）达到了 UDVA 20/40 或以上，9 只（53%）增加了 >或= 2 行 CDVA。
对于高度像差角膜，采用定制化 TNT 的基于地形图引导的激光治疗，联合圆锥角膜和扩张症的 CXL，是一种有效、安全、越来越可预测的选择。
