Knezović Igor, Djurić Sara
Eye Institute Knezović, Zagreb, Croatia.
Case Rep Ophthalmol Med. 2022 Jul 21;2022:1839848. doi: 10.1155/2022/1839848. eCollection 2022.
To report a new method with which we have treated a 29-year-old patient with keratoconus and progressive bilateral visual loss during the past few years.
The patient underwent inferotemporal decentered individualized sphero-cylindrical (DISC) ablation and crosslinking (CXL) of the left eye. After administration of topical anesthetic, the patient was subjected to phototherapeutic keratectomy (PTK) laser ablation of the central 7.0 mm optical zone with 50 m depth of epithelial ablation. To avoid the possible outcome of corneal haze, 0.02% mitomycin C (MMC) was applied to the stromal surface for 40 seconds. Riboflavin 0.1% solution was then administered topically every 2 minutes for a 30-minute period followed by 5 cycles of corneal crosslinking, radiating with UV-A at 3 mW/cm, for a duration of 5 minutes.
17 months postoperative, there was an impressive improvement in uncorrected distance visual acuity, and the cornea became more regular. Results of Fourier's analysis imply a drop of irregularity (-28.6% two months and -63% seventeen months postoperative), Zernike analysis revealed a decrease of higher order aberrations (spheric and comatic aberrations), and corneal index values in the 8 mm zone (IHD, ISV, and IVA) became lower, compared to the preoperative values.
It is possible to obtain better outcome of visual function with DISC ablation through an individual approach compared to CXL solely. This approach might be a promising strategy in retrieving impaired vision in patients suffering from keratoconus.
报告一种新方法，在过去几年中我们用该方法治疗了一名29岁的圆锥角膜患者，其双眼视力进行性下降。
该患者接受了左眼颞下偏心个体化球柱镜（DISC）消融和交联（CXL）治疗。局部麻醉后，对患者进行光治疗性角膜切除术（PTK），对中央7.0毫米光学区进行激光消融，上皮消融深度为50微米。为避免角膜混浊的可能结果，将0.02%丝裂霉素C（MMC）应用于基质表面40秒。然后每2分钟局部应用0.1%核黄素溶液，持续30分钟，随后进行5次角膜交联，用3毫瓦/平方厘米的紫外线A照射，持续5分钟。
术后17个月，未矫正远视力有显著改善，角膜变得更规则。傅里叶分析结果显示不规则度下降（术后2个月为-28.6%，术后17个月为-63%），泽尼克分析显示高阶像差（球差和彗差）减少，与术前值相比，8毫米区域的角膜指数值（IHD、ISV和IVA）降低。
与单纯CXL相比，通过个体化方法进行DISC消融有可能获得更好的视觉功能结果。这种方法可能是恢复圆锥角膜患者受损视力的一种有前景的策略。
