Gordillo Carlos H, Grandin Juan C, Zaldivar Roger, Zaldivar Roberto, Lotfi Adriana C
Department of Corneal Disease, Instituto Zaldivar, Mendoza, Argentina.
Cornea. 2017 Feb;36(2):144-147. doi: 10.1097/ICO.0000000000001104.
To evaluate outcomes, efficacy, and safety of intrastromal corneal ring segment implantation for treatment of keratoconus combined with collagen cross-linking (CXL) with 1-year follow-up.
One hundred nineteen eyes of 82 patients with keratoconus (37 females) underwent femtosecond (Intralase FS; Abbott Medical Optics, Inc) laser-assisted intrastromal corneal ring segment implantation (INTRASEG; Gamma Vision) with flash CXL (18 mW/cm for 5 minutes). The outcome measures were uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), subjective refractive error, keratometry values, and corneal thickness.
Mean age of patients at implantation was 31 years (range 12-63, SD 9.5). According to the Amsler-Krumeich scale of keratoconus severity, 62 eyes were type 1 (52%), 43 eyes, type 2 (36%), and 14 eyes, type 3 (11.8%). Statistically significant improvement of UDVA/CDVA and reduction in the mean cylinder and mean keratometry at 1 year were observed. Mean UDVA (logMAR) was 1.11 ± 0.61 (SD) preoperatively and 0.54 ± 0.58 (SD) postoperatively (P < 0.001). Mean CDVA was 0.52 ± 0.18 (SD) preoperatively and was 0.14 ± 0.17 (P < 0.0001) postoperatively. Preoperative Kmax was 48.75 diopters (D) (range 41.0-55.0 D), and postoperative Kmax was 46.18 D (P < 0.0006); preoperative Kmin was 44.69 D (SD) 3.59 and postoperative Kmin was 43.00 D (SD) 2.53. The mean cylinder was -5.19 D preoperatively (range -0.80 to -8.80 D) and -2.6 D (range -1.00 to -7.25) postoperatively. Mean corneal pachymetry was 486.6 μm (range 391-591). No intraoperative complications occurred. No patient lost any lines of UDVA or CDVA.
Implantation of the INTRASEG with the Intralase combined with flash CXL was apparently safe and effective in treatment of keratoconus. The variety of options in thickness and arc length of the segments enables more precise correction of keratoconus and refractive errors.
评估基质内角膜环植入联合胶原交联（CXL）治疗圆锥角膜1年随访的疗效、有效性和安全性。
82例圆锥角膜患者（37例女性）的119只眼接受了飞秒（Intralase FS；雅培医疗光学公司）激光辅助基质内角膜环植入（INTRASEG；伽马视觉）联合快速CXL（18 mW/cm，持续5分钟）。观察指标包括裸眼远视力（UDVA）、最佳矫正远视力（CDVA）、主观屈光不正、角膜曲率值和角膜厚度。
植入时患者的平均年龄为31岁（范围12 - 63岁，标准差9.5）。根据圆锥角膜严重程度的Amsler-Krumeich分级，62只眼为1型（52%），43只眼为2型（36%），14只眼为3型（11.8%）。观察到1年时UDVA/CDVA有统计学意义的改善，平均柱镜度和平均角膜曲率降低。术前平均UDVA（logMAR）为1.11±0.61（标准差），术后为0.54±0.58（标准差）（P < 0.001）。术前平均CDVA为0.52±0.18（标准差），术后为0.14±0.17（P < 0.0001）。术前最大角膜曲率（Kmax）为48.75屈光度（D）（范围41.0 - 55.0 D），术后为46.18 D（P < 0.0006）；术前最小角膜曲率（Kmin）为44.69 D（标准差3.59），术后为43.00 D（标准差2.53）。术前平均柱镜度为 - 5.19 D（范围 - 0.80至 - 8.80 D），术后为 - 2.6 D（范围 - 1.00至 - 7.25）。平均角膜厚度为486.6 μm（范围391 - 591）。术中无并发症发生。没有患者UDVA或CDVA下降。
Intralase联合快速CXL植入INTRASEG治疗圆锥角膜明显安全有效。环片厚度和弧长的多种选择能够更精确地矫正圆锥角膜和屈光不正。
