Moshirfar Majid, Skanchy David F, Rosen David B, Heiland Madeline B, Liu Harry Y, Buckner Benjamin, Gomez Aaron T, Ronquillo Yasmyne C, Melton Tim, Hoopes Phillip C Jr
John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA.
Utah Lions Eye Bank, Murray, UT, USA.
Med Hypothesis Discov Innov Ophthalmol. 2019 Fall;8(3):129-133.
The purpose of this study was to report visual prognosis after explantation of a small-aperture corneal inlay used for the treatment of presbyopia. This is a retrospective case series conducted at a single site in Draper, Utah, USA (Hoopes Vision). Medical records of 176 patients who had received a small-aperture corneal inlay (KAMRA™, AcuFocus Inc., Irvine, CA, USA) were reviewed. Patients who had undergone explantation of the device were identified. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), and manifest refraction spherical equivalent (MRSE) were measured pre-implantation, post-implantation, pre-explantation, and post-explantation of the inlay. Ten eyes from ten patients were included in this study. The explantation rate was 5.7% over 31 months, with blurry vision as the most common complaint. After explantation, six patients achieved pre-implantation UDVA, and six achieved pre-implantation UNVA. Eight of nine patients who underwent final manifest refraction achieved pre-operative CDVA. All patients had residual donut-shaped corneal haze in the stroma at the previous position of the inlay. All patients experienced improvement in haze with 20% experiencing complete resolution. The degree of stromal haze was not related to the duration of implantation. Of the subset of patients who underwent explantation of their small-aperture corneal inlay, there was persistent loss of CDVA in 10%. The majority of patients experienced some level of residual stromal haze, which may contribute to deficits in UNVA and CDVA in few patients. A hyperopic shift induced by the corneal inlay may contribute to the blurry vision these patients experienced; there was a reduction of this shift post-explantation. While this device is removable, patients should expect some post-explantation changes such as residual haze with a small subset experiencing persistent deficits in CDVA.
本研究的目的是报告用于治疗老花眼的小孔径角膜镶嵌物取出术后的视力预后情况。这是在美国犹他州德雷珀的一个地点（胡普斯视力中心）进行的一项回顾性病例系列研究。回顾了176例接受小孔径角膜镶嵌物（KAMRA™，美国加利福尼亚州欧文市的AcuFocus公司）植入的患者的病历。确定了已取出该装置的患者。在植入前、植入后、取出前和取出后测量未矫正远视力（UDVA）、未矫正近视力（UNVA）、矫正远视力（CDVA）和明显验光球镜等效值（MRSE）。本研究纳入了来自10名患者的10只眼。在31个月的时间里，取出率为5.7%，最常见的主诉是视力模糊。取出后，6例患者达到植入前的UDVA，6例患者达到植入前的UNVA。接受最终明显验光的9例患者中有8例达到术前CDVA。所有患者在镶嵌物先前位置的基质中都有残留的甜甜圈状角膜混浊。所有患者的混浊情况都有所改善，20%的患者完全消退。基质混浊程度与植入时间无关。在接受小孔径角膜镶嵌物取出的患者亚组中，10%的患者CDVA持续下降。大多数患者经历了一定程度的残留基质混浊，这可能导致少数患者的UNVA和CDVA下降。角膜镶嵌物引起的远视性移位可能导致这些患者出现视力模糊；取出后这种移位有所减少。虽然该装置是可取出的，但患者应预期取出后会有一些变化，如残留混浊，一小部分患者会出现CDVA持续下降。
