角膜环段植入术治疗青少年圆锥角膜的两年随访。
Two-Year Follow-up of Intracorneal Ring Segments Implantation in Adolescent Patients With Keratoconus.
出版信息
J Refract Surg. 2021 Feb 1;37(2):91-97. doi: 10.3928/1081597X-20201123-03.
PURPOSE
To evaluate the visual, refractive, topographic, and aberrometric outcomes after intracorneal ring segments (ICRS) implantation in adolescent patients with keratoconus.
METHODS
A retrospective longitudinal study was undertaken with a total of 61 eyes from 47 patients with keratoconus, aged between 13 and 18 years, implanted with a Ferrara-type ICRS. Topography (flattest keratometry, steepest keratometry, and asphericity), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error (sphere and cylinder), and aberrometric measurements (spherical aberration and vertical coma) were evaluated before surgery and at 1 month, 6 months, 1 year, and 2 years after surgery.
RESULTS
UDVA exhibited a statistically significant increase at all times from 1 month to 2 years postoperatively (P < .001), whereas CDVA showed a statistically significant improvement at 1 month, 6 months, and 2 years (P < .002), but dropped in significance at 1 year postoperatively (P = .097). The refractive error analysis showed no variation in statistical significance in the sphere (P = .712) after 2 years. The cylinder presented a statistically significant decrease in diopters at all times from preoperatively to 2 years postoperatively (P < .007). Steepest keratometry manifested a statistically significant decrease in steepness at all times after surgery (P < .001), whereas flattest keratometry lost significance at 1 year (P = .298) and 2 years (P = .053) postoperatively. There was no statistically significant change in the spherical aberration at any of the measured times. The vertical coma was only significantly different at 2 years postoperatively (P = .001).
CONCLUSIONS
ICRS implantation is a safe and effective treatment for improving visual and corneal morphological parameters as shown at 2 years of follow-up in adolescent patients with keratoconus. It is a good option to flatten and regularize the cornea and to temporarily improve the quality of life of young patients and delay the need for keratoplasty. [J Refract Surg. 2021;37(2):91-97.].
目的
评估青少年圆锥角膜患者行角膜内环植入术后的视力、屈光、地形和像差结果。
方法
回顾性纵向研究共纳入 47 例（61 只眼）年龄在 13 至 18 岁的圆锥角膜患者，均植入 Ferrara 型 ICRS。术前及术后 1 个月、6 个月、1 年和 2 年，分别对患者进行地形图（最平角膜曲率、最陡角膜曲率和非球面性）、未矫正远视力（UDVA）、矫正远视力（CDVA）、屈光不正（球镜和柱镜）和像差（球差和垂直彗差）检查。
结果
术后 1 个月至 2 年，UDVA 均有统计学意义的显著提高（P <.001），而 CDVA 在术后 1 个月、6 个月和 2 年时均有统计学意义的改善（P <.002），但在术后 1 年时改善无统计学意义（P =.097）。屈光不正分析显示，术后 2 年时球镜的变化无统计学意义（P =.712）。术后各时间点柱镜均有统计学意义的降低（P <.007）。术后各时间点最陡角膜曲率的陡峭度均有统计学意义的降低（P <.001），而最平角膜曲率在术后 1 年（P =.298）和 2 年（P =.053）时无统计学意义。在任何测量时间点，球差均无统计学意义的变化。术后仅在 2 年时垂直彗差有统计学意义的差异（P =.001）。
结论
在青少年圆锥角膜患者中，ICRS 植入术是一种安全有效的治疗方法，可改善视力和角膜形态参数，在 2 年的随访中得到证实。该术式可使角膜变平、规则化，暂时改善年轻患者的生活质量，延缓角膜移植的需要。
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