National Centre of Ophthalmology named after academician Zarifa Aliyeva, Baku, Azerbaijan.
PLoS One. 2022 Mar 7;17(3):e0264030. doi: 10.1371/journal.pone.0264030. eCollection 2022.
This study performs comparative assessment of the results of different types of two-stage surgical treatment in patients with keratoconus, including combination of corneal collagen cross-linking with intrastromal corneal ring segments followed by topography-guided photorefractive keratectomy.
Prospective review of 101 patients (101 eyes) with keratoconus was performed. Patients underwent corneal collagen cross-linking (32 patients), intrastromal corneal ring segments (48 patients), and a combination of these two procedures (21 patients). Transepithelial topography-guided photorefractive keratectomy was performed as the second stage of treatment in all patients with obtained stable refractive results at 8 months after first stage. Main outcome measures were visual acuity (uncorrected distance and corrected distance) and corneal topographic indices.
Comparison of the studied parameters after first stage surgical treatment between non-combined CXL and combined groups demonstrated a statistically significant difference for uncorrected distance visual acuity, corrected distance visual acuity, and cylindrical refraction values (p<0.05). We observed significant improvement of visual acuity and key corneal topographic indices after topography-guided photorefractive keratectomy in all study groups (p<0.05). In 50 (49.5%) patients customized excimer laser ablation gave the possibility of full spherical and cylindrical corrections. Ten eyes (10%) had delayed epithelial healing, no corneal stromal opacities developed.
This study shows that combined two-stage surgical treatment of keratoconus, consisting of intrastromal corneal ring segment implantation with corneal collagen cross-linking followed by topography-guided photorefractive keratectomy, is clinically more effective to prevent keratectasia progression and increase visual acuity than the use of non-combined two-stage techniques.
本研究对不同类型的圆锥角膜两阶段手术治疗结果进行了比较评估，包括角膜胶原交联联合基质内角膜环段植入术，随后行基于角膜地形图的准分子激光光屈光性角膜切削术。
对 101 例（101 只眼）圆锥角膜患者进行前瞻性回顾。患者接受了角膜胶原交联（32 例）、基质内角膜环段植入术（48 例）和这两种方法联合治疗（21 例）。所有患者在第一阶段治疗 8 个月后获得稳定的屈光结果时，行基于角膜地形图的经上皮准分子激光光屈光性角膜切削术作为第二阶段治疗。主要观察指标为视力（未矫正的远视力和矫正的远视力）和角膜地形学指数。
在非联合 CXL 组和联合组之间，对第一阶段手术治疗后研究参数进行比较，未矫正的远视力、矫正的远视力和柱镜屈光度有统计学差异（p<0.05）。我们观察到所有研究组在基于角膜地形图的准分子激光光屈光性角膜切削术后视力和主要角膜地形学指数显著改善（p<0.05）。在 50 例（49.5%）患者中，定制准分子激光消融术可实现全球镜和柱镜的完全矫正。10 只眼（10%）出现延迟上皮愈合，无角膜基质混浊发生。
本研究表明，由基质内角膜环段植入联合角膜胶原交联，随后行基于角膜地形图的准分子激光光屈光性角膜切削术的两阶段联合手术治疗，与非联合两阶段技术相比，在预防圆锥角膜进展和提高视力方面更具临床疗效。
