Hosny Mohamed, Nour Moustafa, Azzam Sarah, Salem Mohsen, El-Mayah Esraa
Department of Ophthalmology, Cairo University, Giza, Egypt.
Clin Ophthalmol. 2018 Jan 17;12:147-152. doi: 10.2147/OPTH.S151313. eCollection 2018.
The purpose of this study is to compare the efficacy of intratunnel cross-linking combined with intrastromal corneal ring segment (ICRS) implantation versus combined epithelium-off (epi-off) cross-linking and ICRS implantation for the management of keratoconus.
Our study included 20 eyes of 12 patients with moderate-to-severe keratoconus. Group A included 10 eyes that underwent simultaneous ICRS implantation with intratunnel cross-linking. Group B included 10 eyes that underwent simultaneous ICRS implantation with epi-off cross-linking. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest sphere and cylinder, mean and maximum keratometric readings, corneal thickness at pachy apex and thinnest location, as well as corneal hysteresis (CH) and corneal resistance factor (CRF) were compared preoperatively and at 6 months postoperatively.
The mean UDVA and CDVA improved significantly in both groups with a statistically nonsignificant difference between the groups (=0.798 and 0.126, respectively). The manifest cylinder decreased significantly in both groups, while the manifest sphere decreased significantly in Group A but nonsignificantly in Group B with a statistically nonsignificant difference between the groups (=0.773 and 0.111, respectively). Both techniques led to significant flattening of the cornea and a significant decrease of and with a statistically nonsignificant difference between the groups (=0.312 and 0.857, respectively). There was a statistically significant decrease in CH in both groups postoperatively; however, there was a statistically nonsignificant increase in CRF after both techniques with a statistically nonsignificant difference between the groups in the mean change of CH and CRF (=0.633 and 0.313, respectively). No intraoperative or postoperative complications were observed in both groups.
Both techniques improved the visual and refractive outcomes in cases of moderate and severe keratoconus with no statistically significant difference between the groups; however, simultaneous intratunnel cross-linking and ICRS implantation showed early visual rehabilitation due to the absence of epithelial defect.
本研究旨在比较隧道内交联联合基质内角膜环片（ICRS）植入术与去上皮（epi-off）交联联合ICRS植入术治疗圆锥角膜的疗效。
本研究纳入了12例中重度圆锥角膜患者的20只眼。A组包括10只同时接受ICRS植入和隧道内交联的眼。B组包括10只同时接受ICRS植入和去上皮交联的眼。比较术前及术后6个月的未矫正远视力（UDVA）、矫正远视力（CDVA）、明显球镜和柱镜、平均及最大角膜曲率读数、角膜最厚点和最薄处的角膜厚度，以及角膜滞后（CH）和角膜阻力因子（CRF）。
两组的平均UDVA和CDVA均显著改善，组间差异无统计学意义（分别为=0.798和0.126）。两组的明显柱镜均显著降低，而A组的明显球镜显著降低，B组则无显著降低，组间差异无统计学意义（分别为=0.773和0.111）。两种技术均导致角膜明显变平，以及和显著降低，组间差异无统计学意义（分别为=0.312和0.857）。两组术后CH均有统计学意义的降低；然而，两种技术后CRF均有统计学意义的升高，两组CH和CRF的平均变化差异无统计学意义（分别为=0.633和0.313）。两组均未观察到术中或术后并发症。
两种技术均改善了中重度圆锥角膜患者的视力和屈光结果，组间差异无统计学意义；然而，由于不存在上皮缺损，同时进行隧道内交联和ICRS植入显示出早期视力恢复。
