SU Yonsei Eye Clinic, Seoul, Republic of Korea.
Department of Ophthalmology, Institute of Vision Research, Eye and Ear Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Biomed Res Int. 2019 Jul 8;2019:7850216. doi: 10.1155/2019/7850216. eCollection 2019.
To report one-year outcomes of a modified version of two-stage multimodal surgical protocol for moderate keratoconus which has been suggesting promising preliminary results.
30 eyes of 25 patients with moderate keratoconus who exhibited visual complaints and/or disease progression were included for this retrospective case study. Approximately 3 months after implantation of intracorneal ring segment (Intacs SK™), a combination of corneal wavefront-guided transepithelial photorefractive keratectomy (CWG-transPRK, Schwind Amaris® 1050, and Schwind Sirius) and accelerated collagen cross-linking (accCXL, Avedro KXL™) was performed. Patients were examined for uncorrected and corrected distance visual acuity (UDVA; CDVA), keratometric power (K), corneal thickness, and corneal higher-order aberrations (HOAs) preoperatively and at postoperative 1, 3, 6, and 12 months.
The median UDVA and mean CDVA were enhanced from 6/38 to 6/12 and from 6/19 to 6/7.5, respectively, through 12 months after CWG-transPRK/accCXL. The 12-month CDVA of all patients was better than 6/12 Snellen, and no subject lost one or more lines of CDVA. The magnitudes of both myopia and corneal steepness were decreased in turn by Intacs SK implantation and also by CWG-transPRK/accCXL, but the reduction in HOA was largely the result of CWG-transPRK/accCXL. The magnitude of corneal thinning stabilized within 3 months after CWG-transPRK/accCXL.
This approach may allow patients with moderate keratoconus to obtain satisfactory vision without the need for contact lens wear. This surgery appeared to be effective and safe through 1 year of follow-up.
报告一种改良的两阶段多模态手术方案治疗中度圆锥角膜的一年结果，该方案已显示出有希望的初步结果。
本回顾性病例研究纳入了 25 名患有中度圆锥角膜的患者的 30 只眼，这些患者出现了视觉问题和/或疾病进展。在植入角膜内环段（Intacs SK™）后约 3 个月，进行了角膜波前引导的经上皮光性角膜切削术（CWG-transPRK，Schwind Amaris® 1050 和 Schwind Sirius）与加速胶原交联（accCXL，Avedro KXL™）的联合治疗。患者在术前和术后 1、3、6 和 12 个月接受了未矫正和矫正距离视力（UDVA；CDVA）、角膜曲率（K）、角膜厚度和角膜高阶像差（HOAs）的检查。
通过 CWG-transPRK/accCXL，术后 12 个月 UDVA 和平均 CDVA 分别从 6/38 提高到 6/12 和从 6/19 提高到 6/7.5。所有患者的 12 个月 CDVA 均优于 6/12 视力表，没有患者失去一行或更多行的 CDVA。Intacs SK 植入和 CWG-transPRK/accCXL 依次降低了近视和角膜陡峭度的程度，但 HOAs 的减少主要是 CWG-transPRK/accCXL 的结果。在 CWG-transPRK/accCXL 后 3 个月内，角膜变薄的程度稳定。
这种方法可以使患有中度圆锥角膜的患者获得满意的视力，而无需佩戴隐形眼镜。通过 1 年的随访，该手术似乎是有效和安全的。
