Department of Cornea and Refractive surgery, Narayana Nethralaya, Bangalore, India.
Imaging, Biomechanics and mathematical modelling solutions lab, Narayana Nethralaya foundation, Bangalore, India.
Asia Pac J Ophthalmol (Phila). 2020 Dec 22;10(2):152-160. doi: 10.1097/APO.0000000000000342.
The aim of this study was to assess the visual, topographic, and aberrometric outcomes of a novel tissue sparing technique, topography-guided removal of epithelium, and stroma in keratoconus (TRESK) along with accelerated collagen cross-linking (CXL), 1 month after Intacs insertion.
Prospective interventional study.
Fourty-eight eyes (45 patients) with keratoconus underwent femto-assisted Intacs insertion. After 1 month, TRESK and CXL (9 mW/cm2 for 10 minutes) was done. TRESK is a decentered trans-PTK (phototherapeutic keratectomy) with center and area of ablation at the location of the steepest tangential anterior curvature and area of the cone respectively. Total ablation (epithelium plus stroma) was limited to 75 μm. Postoperative measurements were performed 1 month after Intacs, 6 weeks after Intacs followed by TRESK/CXL, and at the final visit 12 months after Intacs followed by TRESK/CXL.
For all eyes studied, uncorrected distance visual acuity and corrected distance visual acuity (CDVA) (logMAR) improved from preoperative means of 1.05 ± 0.05 and 0.31 ± 0.03 logMAR to postoperative means of 0.52 ± 0.05 (P < 0.001) and 0.20 ± 0.02 logMAR (P = 0.009), respectively. The mean preoperative sphere, cylinder and mean refractive spherical equivalent decreased from -4.52 ± 0.98 D, -4.81 ± 0.25 D, -6.93 ± 0.99 D to -0.77 ± 0.53 D (P = 0.029), -3.13 ± 0.24 D (P = 0.002), and -2.34 ± 0.53 D (P = 0.021), respectively with a mean keratometric flattening of 5.06D (P < .0001) at the final visit. In total, 2.08% of the eyes lost 1 Snellen line of CDVA. Sixty eight percent and 27% of the eyes gained 2 Snellen lines or more of uncorrected distance visual acuity and CDVA, respectively.
Simultaneous TRESK with CXL done 1 month after Intacs insertion (I-TRESK) in keratoconus eyes provided significant visual gain with refractive and topographic improvement. This novel procedure involving customized PTK before CXL is safe, easy to plan and perform, and provides good outcomes.
本研究旨在评估一种新型组织节约技术（TRESK）——角膜地形图引导的角膜上皮和基质去除术联合加速胶原交联（CXL）的视力、地形和像差结果，在 Intacs 插入后 1 个月。
前瞻性干预研究。
48 只眼（45 例）圆锥角膜患者行飞秒辅助 Intacs 插入术。1 个月后，行 TRESK 和 CXL（9 mW/cm2，10 分钟）。TRESK 是一种偏心的经皮光热角膜切削术（PTK），消融区的中心和面积位于最陡切线前曲率的位置，圆锥区的面积分别位于圆锥区。总消融（上皮加基质）限制在 75μm 以内。Intacs 术后 1 个月、Intacs 后 6 周行 TRESK/CXL 后、Intacs 后 12 个月行 TRESK/CXL 后进行术后测量。
所有研究眼的未矫正远视力和矫正远视力（logMAR）均从术前的 1.05±0.05 和 0.31±0.03 logMAR 分别提高到术后的 0.52±0.05（P<0.001）和 0.20±0.02 logMAR（P=0.009）。术前平均球镜、柱镜和平均屈光球镜等效值分别从-4.52±0.98 D、-4.81±0.25 D、-6.93±0.99 D 下降至-0.77±0.53 D（P=0.029）、-3.13±0.24 D（P=0.002）和-2.34±0.53 D（P=0.021），最终随访时平均角膜平坦度为 5.06D（P<0.0001）。总的来说，有 2.08%的眼失去了 1 行 CDVA。68%和 27%的眼分别获得了 2 行或更多的未矫正远视力和 CDVA。
圆锥角膜眼 Intacs 插入后 1 个月行 TRESK 联合 CXL（I-TRESK）可显著提高视力，改善屈光和地形。这种新型的在 CXL 前进行定制化 PTK 的手术操作安全、易于规划和执行，并能提供良好的效果。
