Bikbova Guzel, Kazakbaeva Gyulli, Bikbov Mukharram, Usubov Emin
Ufa Eye Research Institute, Ufa, Russia.
Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Inohana 1-8-1, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
Int Ophthalmol. 2018 Jun;38(3):1285-1293. doi: 10.1007/s10792-017-0593-4. Epub 2017 Jun 15.
To estimate the effectiveness of complete corneal ring (MyoRing) implantation compared with MyoRing implantation combined with corneal collagen crosslinking (CXL) for keratoconus treatment for 36 months follow-up.
Retrospective cohort study.
MyoRing implantation was performed in a series of 78 patients (80 eyes) with keratoconus II-III Amsler classification, of these 39 eyes had MyoRing implantation combined with CXL. Implantation of a MyoRing in the corneal pocket was performed using a PocketMaker microkeratome and corneal intrastromal implantation system. During CXL, riboflavin solution 0.1% was injected into the corneal pocket through the incision tunnel and standard surface UVA irradiation (370 nm, 3 mW/cm) was then applied from 5-cm distance for 30 min.
Significant improvements in uncorrected distance visual acuity and corrected distance visual acuity were observed for both groups, which was relatively better 12 months after procedure in MyoRing alone group; however, in 36 months there was no difference between groups. Keratometry was reduced in both groups; after MyoRing implantation for 8.45 D and MyoRing + CXL for 9.43 D, the spherical equivalent decreased from 8.45 to 7.72 D and from 9.43 to 6.25 D, respectively. The cylinder decreased to 3.33 D with MyoRing alone and to 3.31 D with MyoRing + CXL. Corneal thickness remained nearly unchanged (from 433.69 ± 38.76 to 434.21 ± 34.98) in MyoRing group and decreased from baseline (from 426.93 ± 46.58 to 401.24 ± 39.12 µm) in MyoRing + CXL group 36 months postoperatively, which corresponds with pachymetry reduction after conventional CXL.
Both MyoRing implantation and MyoRing combined with CXL were effective for treating keratoconus. At 36 months, there were slightly better outcomes in MyoRing + CXL group; however, in MyoRing alone group visual and refractive outcomes were stable overtime.
评估单纯角膜环（MyoRing）植入术与角膜环植入联合角膜胶原交联（CXL）治疗圆锥角膜36个月随访期的有效性。
回顾性队列研究。
对78例（80眼）Amsler分类为II - III级的圆锥角膜患者行角膜环植入术，其中39眼行角膜环植入联合CXL。使用PocketMaker微型角膜刀和角膜基质内植入系统在角膜基质袋内植入角膜环。在CXL过程中，通过切口隧道将0.1%的核黄素溶液注入角膜基质袋，然后从5 cm距离处以3 mW/cm的标准表面紫外线A（UVA）照射30分钟。
两组患者的裸眼远视力和矫正远视力均有显著改善，单纯角膜环组术后12个月改善相对较好；然而，36个月时两组之间无差异。两组的角膜曲率均降低；角膜环植入后降低8.45 D，角膜环 + CXL后降低9.43 D，等效球镜分别从8.45 D降至7.72 D和从9.43 D降至6.25 D。单纯角膜环组柱镜降至3.33 D，角膜环 + CXL组降至3.31 D。角膜环组角膜厚度术后36个月几乎保持不变（从433.69±38.76变为434.21±34.98），角膜环 + CXL组从基线（从426.93±46.58变为401.24±39.12 µm）下降，这与传统CXL后的角膜测厚减少一致。
角膜环植入术和角膜环联合CXL治疗圆锥角膜均有效。36个月时，角膜环 + CXL组效果略好；然而，单纯角膜环组的视力和屈光效果随时间推移稳定。
