Bakhsh Ashraf M, Elwan Shaaban A M, El-Atris Tamer M, Al-Salowle Abdulrahman M, Alsamnan Mazen S
Department of Ophthalmology, Security Forces Hospital, Riyadh, Saudi Arabia.
Department of Ophthalmology, Faculty of Medicine, Al-Faisal University, Riyadh, Saudi Arabia.
Saudi J Ophthalmol. 2022 Jul 11;36(1):53-63. doi: 10.4103/sjopt.sjopt_26_20. eCollection 2022 Jan-Mar.
Keratoconus (KC) leads to gradual progressive loss of vision in young and adult patients. For the purpose of visual rehabilitation and for hindering KC progression in patients, we designed this study. The main aim of this study is to help the KC patients to improve and stabilize their vision.
This prospective consecutive uncontrolled study includes 36 eyes of 36 patients with moderate degree of KC. All patients underwent combined wavefront-guided transepithelial photorefractive keratectomy (TPRK) and accelerated corneal collagen cross-linking (ACXL) after intracorneal ring segment (ICRS) implantation. Different measures will be evaluated at baseline, after ICRS implantation, and at one, 3, 6, and 12 months after combined (TPRK and ACXL). These measurements are uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal indices based on Scheimpflug tomography, and higher-order aberrations (HOAs) based on (Sirius, Schwind) tomography.
There were significant improvements in logMAR (UDVA and CDVA) and reduction in sphere, manifest cylinder, MRSE, maximal keratometry, and mean keratometry after ICRS implantation in the first stage. After TPRK and ACXL as the second stage, there were significant improvements in visual acuity of both logMAR UDVA and CDVA. Reduction in refractive outcomes, including MRSE, sphere, and manifest cylinder. All corneal indices including steep, flat, mean, and maximal keratometries had been decreased. Furthermore, there were significant improvements in the final root mean square, HOAs, and coma aberrations from baseline.
In moderate KC, triple therapy of ICRS implantation followed by combined TPRK and ACXL appears to be a safe and effective approach. This approach provides an improvement in visual acuity, refraction, corneal indices, and HOAs. These improvements were maintained for 1 year postoperatively. It also halts KC progression.
圆锥角膜（KC）会导致年轻及成年患者的视力逐渐进行性丧失。为了实现视力康复并阻止患者的KC病情进展，我们设计了本研究。本研究的主要目的是帮助KC患者提高并稳定其视力。
这项前瞻性连续非对照研究纳入了36例中度KC患者的36只眼。所有患者在植入角膜内环（ICRS）后接受了波前引导的经上皮准分子激光角膜切削术（TPRK）和加速角膜胶原交联（ACXL）联合治疗。将在基线、ICRS植入后以及联合治疗（TPRK和ACXL）后的1个月、3个月、6个月和12个月评估不同指标。这些指标包括裸眼远视力（UDVA）、矫正远视力（CDVA）、显然验光球镜等效度（MRSE）、基于眼前节分析系统断层扫描的角膜指数以及基于（Sirius、Schwind）断层扫描的高阶像差（HOAs）。
在第一阶段ICRS植入后，logMAR（UDVA和CDVA）有显著改善，球镜、柱镜、MRSE、最大角膜曲率和平均角膜曲率降低。在作为第二阶段的TPRK和ACXL治疗后，logMAR UDVA和CDVA的视力均有显著改善。屈光结果包括MRSE、球镜和柱镜均降低。所有角膜指数，包括陡峭、平坦、平均和最大角膜曲率均下降。此外，与基线相比，最终均方根、HOAs和彗差像差有显著改善。
在中度KC中，先植入ICRS，然后联合TPRK和ACXL的三联疗法似乎是一种安全有效的方法。这种方法可改善视力、屈光、角膜指数和HOAs。这些改善在术后1年得以维持。它还能阻止KC病情进展。
