Keratoconus National Reference Center (CRNK), Anterior Segment unit, university center hospital of Bordeaux, Bordeaux, France.
Department of ophthalmology, refractive surgery unit, Shaare Zedek medical center, Jerusalem, Israel.
J Fr Ophtalmol. 2022 Dec;45(10):1117-1125. doi: 10.1016/j.jfo.2022.03.016. Epub 2022 Nov 2.
To evaluate the safety and visual outcomes of intrastromal corneal ring segment (ICRS) implantation followed by transepithelial phototherapeutic keratectomy (te-PTK) and corneal cross-linking (CXL) in patients with mild keratoconus.
Patients with mild keratoconus and contact lens intolerance who underwent sequential ICRS implantation followed by phototherapeutic keratectomy and corneal CXL between April 2015 and July 2018 were retrospectively included in the study. Refractive and visual outcomes, satisfaction questionnaire and complications were recorded at the last follow-up (mean 9.5 months postoperatively).
Twenty eyes of 17 patients were enrolled, including 5 women and 15 men. The mean time between the two procedures was 16 months. Based on values before the first procedure and 9.5 months after the second procedure, significant improvements were noted in uncorrected distance visual acuity (UDVA) (0.80±0.35 logMAR vs. 0.46±0.38 logMAR), corrected distance visual acuity (CDVA) (0.38±0.23 logMAR vs. 0.13±0.16 logMAR), maximal K (56.11±4 diopters [D] vs. 50.6±3.56 D), mean K (51.87±3.43 D vs. 48.45±2.91 D), cylinder (7.99±3.94 D vs. 4.23±3.49 D), and spherical equivalent (-3.84±3.36 D vs. -0.99±2.15 D) (P<0.01). Among the outcomes, we noted 5 (25%) superficial corneal scarring (haze); 75% of eyes gained>=1 logMAR line of CDVA. In all, 94.5% of patients reported that they were satisfied with their outcomes.
Combining ICRS implantation followed by te-PTK and corneal CXL appears to be a safe and effective approach for improving visual outcomes and quality of life in keratoconus patients.
评估基质内角膜环段（ICRS）植入联合经上皮光角膜切削术（te-PTK）和角膜交联（CXL）治疗轻中度圆锥角膜患者的安全性和视力结果。
回顾性纳入 2015 年 4 月至 2018 年 7 月期间接受连续 ICRS 植入联合光角膜切削术和角膜交联治疗的轻中度圆锥角膜伴隐形眼镜不耐受患者。在最后一次随访（术后 9.5 个月）时记录屈光和视力结果、满意度问卷和并发症。
共纳入 17 例患者的 20 只眼，其中女性 5 例，男性 15 例。两次手术之间的平均时间为 16 个月。基于第一次手术前和第二次手术后 9.5 个月的值，未矫正远视力（UDVA）（0.80±0.35 logMAR 比 0.46±0.38 logMAR）、矫正远视力（CDVA）（0.38±0.23 logMAR 比 0.13±0.16 logMAR）、最大角膜曲率（56.11±4 屈光度 [D] 比 50.6±3.56 D）、平均角膜曲率（51.87±3.43 D 比 48.45±2.91 D）、角膜散光（7.99±3.94 D 比 4.23±3.49 D）和等效球镜（-3.84±3.36 D 比 -0.99±2.15 D）均有显著改善（P<0.01）。结果中，我们观察到 5 只眼（25%）有轻度的浅层角膜瘢痕（混浊）；75%的眼获得>=1 logMAR 行的 CDVA 提高。总体而言，94.5%的患者报告对其结果满意。
联合 ICRS 植入、te-PTK 和角膜交联似乎是一种安全有效的方法，可以改善圆锥角膜患者的视力和生活质量。
