Assistant Professor of Ophthalmology, Faculty of Medicine, Ain Shams University.
Cornea and Refractive Surgery Consultant, Maadi Eye Subspecialty Center.
Cornea. 2023 Jun 1;42(6):755-765. doi: 10.1097/ICO.0000000000003225. Epub 2023 Jan 11.
The aim of this study was to introduce a revised tissue-saving technique for combined topography-guided photorefractive keratectomy (PRK) and cross-linking for keratoconus (KC) treatment and to evaluate its efficacy, safety, and stability.
This retrospective, noncontrolled study was performed at Maadi Eye Subspecialty Center and Eye Care Center, Cairo, Egypt. The technique was performed on virgin keratoconic corneas with 3 different morphological patterns of ectasia. It involves performing topography-guided PRK before epithelial removal, followed by customized phototherapeutic keratectomy (PTK) that is tailored to each cornea after studying the treatment profile on the laser treatment screen. The electronic medical records were explored for preoperative and postoperative data, including subjective refraction and topographic data (using Sirius topographer).
The study was conducted on 123 eyes of 93 patients with a mean age of 27.98 years ±6.06. The follow-up ranged from 6 to 36 months (mean ± SD of 16.2 months ±10.4). The results showed statistically nonsignificant differences among the 3 ectasia subgroups in treatment spherical equivalent, treatment maximum depth, thickness of removed epithelium, and thinnest residual stromal bed. There were statistically significant differences in almost all values between the preoperative and postoperative data, with significant postoperative patients' improvement ( P value <0.001). The subgroups' results were almost the same as the whole cohort's results. The safety and efficacy indices of the performed procedure showed remarkably high values (1.48 ± 0.21 and 0.87 ± 0.40, respectively).
This revised protocol for KC management maximally preserves stromal tissue with proven efficacy, safety, and stability.
本研究旨在介绍一种改良的组织节约型技术，用于治疗圆锥角膜的联合地形图引导性光性折射性角膜切削术（PRK）和交联，评估其疗效、安全性和稳定性。
本回顾性、非对照研究在埃及开罗的 Maadi 眼科专科中心和眼科中心进行。该技术应用于角膜形态不同的 3 种圆锥角膜患者。它涉及在去除上皮之前进行地形图引导性 PRK，然后在激光治疗屏幕上研究治疗方案后，对每个角膜进行定制的光治疗性角膜切削术（PTK）。探索电子病历中的术前和术后数据，包括主观屈光度和地形图数据（使用 Sirius 地形图）。
本研究共纳入 93 例 123 只眼的患者，平均年龄为 27.98 ± 6.06 岁。随访时间为 6 至 36 个月（平均随访时间为 16.2 ± 10.4 个月）。结果显示，在 3 个角膜扩张亚组之间，治疗等效球镜、治疗最大深度、去除上皮的厚度和最薄残留基质床没有统计学差异。术前和术后数据之间几乎所有值都存在统计学差异，患者术后明显改善（P 值＜0.001）。各亚组的结果与整个队列的结果几乎相同。所进行的程序的安全性和疗效指数显示出非常高的值（分别为 1.48 ± 0.21 和 0.87 ± 0.40）。
这种改良的圆锥角膜管理方案最大限度地保留了基质组织，具有疗效、安全性和稳定性。
