Tambe Deepali Sandeep, Ivarsen Anders, Hjortdal Jesper
Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.
Case Rep Ophthalmol. 2015 Aug 5;6(2):260-8. doi: 10.1159/000431306. eCollection 2015 May-Aug.
To assess the efficacy and safety of topography-guided photorefractive keratectomy (PRK) for keratoconus and to estimate the subsequent risk of progression.
This is a retrospective follow-up study. Between 1998 and 2013, 28 eyes of 23 patients (age 17-60) with grade 1-3 keratoconus received topography-guided PRK. Corrected-distance visual acuity (CDVA), keratometry, pachymetry, and corneal topography were assessed before, after 3 months, and at a late follow-up of a median of 7 years after the procedure. Postoperative complications including subsequent keratoplasty were noted.
Of the 28 eyes, 5 (18%percnt;) had undergone corneal transplantation at a median of 7 years (range 3-10) after PRK. Four eyes were not available for follow-up. In the remaining 19 eyes, CDVA was improved in 16 eyes (84.3%percnt;), reduced in 2 eyes (10.5%percnt;), and unchanged in 1 eye (5.2%percnt;). Thus, average CDVA had improved from 0.49 logMAR before PRK to 0.27 logMAR at 3 months, and to 0.24 at the long-term follow-up. The mean spherical equivalent was reduced from - 6.2 to -3.7 dpt after 3 months and to -2.1 dpt at the late follow-up. Similarly, the mean cylinder was reduced from -4.2 to -3.0 dpt after 3 months and at the late follow-up.
Topography-guided PRK in keratoconus may be effective for reducing myopia and astigmatism and may offer a temporary or permanent alternative to keratoplasty in contact lens-intolerant keratoconus. In the present study, we found a low risk of keratoconus progression after PRK.
评估角膜地形图引导的准分子激光角膜切削术（PRK）治疗圆锥角膜的疗效和安全性，并估计后续进展风险。
这是一项回顾性随访研究。1998年至2013年期间，23例（年龄17 - 60岁）1 - 3级圆锥角膜患者的28只眼接受了角膜地形图引导的PRK。在术前、术后3个月以及术后中位7年的晚期随访时评估矫正远视力（CDVA）、角膜曲率测量、角膜厚度测量和角膜地形图。记录术后并发症，包括后续的角膜移植情况。
28只眼中，5只眼（18%）在PRK术后中位7年（范围3 - 10年）接受了角膜移植。4只眼无法进行随访。在其余19只眼中，16只眼（84.3%）的CDVA得到改善，2只眼（10.5%）降低，1只眼（5.2%）不变。因此，平均CDVA从PRK术前的0.49 logMAR提高到术后3个月的0.27 logMAR，长期随访时为0.24。术后3个月平均球镜等效度从 - 6.2降至 -3.7 dpt，晚期随访时降至 -2.1 dpt。同样，术后3个月和晚期随访时平均柱镜度从 -4.2降至 -3.0 dpt。
角膜地形图引导的PRK治疗圆锥角膜可能有效降低近视和散光，对于不耐受隐形眼镜的圆锥角膜患者可能提供临时或永久性的角膜移植替代方案。在本研究中，我们发现PRK术后圆锥角膜进展风险较低。
