Gauthier A-S, Friot M, Montard R, Saleh M, Delbosc B
Service d'ophtalmologie, CHU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon cedex, France.
Service d'ophtalmologie, CHU Jean-Minjoz, 2, boulevard Fleming, 25030 Besançon cedex, France.
J Fr Ophtalmol. 2016 May;39(5):428-36. doi: 10.1016/j.jfo.2016.01.006. Epub 2016 Apr 28.
Intrastromal corneal rings (ICR) have been used for several years for the correction of irregular astigmatism in patients with keratoconus.
To evaluate the effectiveness of femtosecond-assisted ICR implantation for treatment of keratoconus and to define predictive factors of success.
We undertook a retrospective study of patients with keratoconus who underwent femtosecond-assisted Ferrara ICR implantation between December 2012 and May 2014 at the University Hospital of Besançon. To determinate predictive factors of success, we divided patients into 2 groups based on the gain of at least two lines of best corrected visual acuity (BCVA) at 1 year after surgery ("good responders") or the gain of only one line of BCVA, no change, or the loss of lines of BCVA ("poor responders"). For each group, we analyzed preoperative refractive and keratometric values. Moreover, to verify if preoperative visual acuity could be a predictive factor of success, four groups were created based on initial visual acuity, and postoperative BCVA was compared.
We retrospectively studied 32 eyes of 29 patients with keratoconus who underwent femtosecond-assisted Ferrara ICR implantation between December 2012 and May 2014 at the University Hospital of Besançon. From one month to 1 year postoperatively, we observed a significant improvement in BCVA and a significant decrease in cylinder and keratometry values (P<0.05). In total, 90.6% of patients had an increase in visual acuity (VA) of at least one line within 1 year while 9.4% had a decrease or stability of their VA. The average cylinder value decreased from -4.81±2.45 diopters (D) preoperatively to -2.39±1.94 D (P<0.001) at 1 year postoperatively, and the average of the maximum keratometry from 51.14±3.89 D to 48.52±4.00 D (P<0.05). Four predictive factors of success were statistically significant: type of ectasia (type 1 or 2), stage of keratoconus (Krumeich 1 or 2), implantation of only 1 ICR and a preoperative VA less than 0.4 (decimal scale). Eighty-six percent of patients with an initial VA<0.4 (decimal scale) gained 2 lines of BCVA within 1 year and 80% 3 lines versus 52% and 41%, respectively for patients with initial VA≥0.4 (decimal scale).
Femtosecond-assisted Ferrara ICR implantation for treatment of keratoconus is a reliable and reversible technique. Implantation results in greater efficiency for patients with moderately advanced asymmetric keratoconus with an initial VA<0.4 (decimal scale).
角膜基质内环形植片（ICR）已用于圆锥角膜患者不规则散光的矫正数年。
评估飞秒激光辅助ICR植入治疗圆锥角膜的有效性，并确定成功的预测因素。
我们对2012年12月至2014年5月间在贝桑松大学医院接受飞秒激光辅助费拉拉ICR植入的圆锥角膜患者进行了一项回顾性研究。为了确定成功的预测因素，我们根据术后1年最佳矫正视力（BCVA）至少提高两行（“良好反应者”）或仅提高一行BCVA、无变化或BCVA下降（“不良反应者”）将患者分为两组。对于每组，我们分析了术前屈光和角膜曲率值。此外，为了验证术前视力是否可能是成功的预测因素，根据初始视力创建了四组，并比较了术后BCVA。
我们回顾性研究了2012年12月至2014年5月间在贝桑松大学医院接受飞秒激光辅助费拉拉ICR植入的29例圆锥角膜患者的32只眼。术后1个月至1年，我们观察到BCVA有显著改善，柱镜度数和角膜曲率值显著降低（P<0.05）。总体而言，90.6%的患者在1年内视力（VA）至少提高了一行，而9.4%的患者视力下降或稳定。平均柱镜度数从术前的-4.81±2.45屈光度（D）降至术后1年的-2.39±1.94 D（P<0.001），最大角膜曲率平均值从51.14±3.89 D降至48.52±4.00 D（P<0.05）。四个成功的预测因素具有统计学意义：扩张类型（1型或2型）、圆锥角膜分期（克鲁梅希1期或2期）、仅植入1个ICR以及术前VA小于0.4（小数记录法）。初始VA<0.4（小数记录法）的患者中，86%在1年内BCVA提高了两行，80%提高了三行，而初始VA≥0.4（小数记录法）的患者分别为52%和41%。
飞秒激光辅助费拉拉ICR植入治疗圆锥角膜是一种可靠且可逆的技术。对于初始VA<0.4（小数记录法）的中度晚期非对称性圆锥角膜患者，植入术的效果更佳。
