South Australian Institute of Ophthalmology, University of Adelaide and Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
IVISION Laser Eye Surgery, Adelaide, South Australia, Australia; and.
Cornea. 2024 Mar 1;43(3):307-314. doi: 10.1097/ICO.0000000000003354. Epub 2023 Aug 4.
This study aimed to evaluate the efficacy and safety of Keraring implantation followed by simultaneous topography-guided photorefractive keratectomy (TGPRK) and corneal cross-linking (CXL) in the management of keratoconus.
This is a single-center, private practice, retrospective review. Patients with keratoconus who were intolerant to contact lens wear underwent implantation of the Keraring, followed by TGPRK with CXL from 2 to 36 months after implantation. Main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction (cylinder and spherical equivalent), keratometry (steep, maximum, and central), and central corneal thickness (CCT). Patients were followed up for 3 to 60 months postoperatively.
Fifty-seven eyes from 45 patients were included. The mean time between Keraring and TGPRK/CXL was 6.0 ± 6.0 months. Patients were followed up for a mean of 28.6 ± 20.1 months after Keraring insertion. At 12-month follow-up, there was a statistically significant improvement in mean UDVA (0.94 ± 0.49-0.35 ± 0.23, P < 0.01), CDVA (0.39 ± 0.26-0.17 ± 0.15, P < 0.01), cylinder (-4.97 ± 2.68 to -1.74 ± 1.25, P < 0.01), steep keratometry (51.25 ± 3.37-45.03 ± 2.27, P < 0.01), central keratometry (52.59 ± 4.98-46.99 ± 3.53, P < 0.01), and maximum keratometry (58.78 ± 4.22-50.76 ± 3.42, P < 0.01). These results were sustained at 48-month follow-up. CCT decreased at 12 months after TGPRK (461.84 ± 27.46-418.94 ± 45.62, P < 0.01) and remained stable at 60 months. Postoperatively, 2 eyes (3.51%) had corneal haze, resulting in decrease in CDVA; 1 was treated successfully with repeat PRK; and 1 patient (1.75%) had wound melt due to partial Keraring extrusion, which settled with repositioning.
Keraring implantation followed by simultaneous TGPRK and CXL appears to be effective in the long term in improving UDVA, CDVA, cylinder, CCT, and keratometry in patients with keratoconus who are intolerant to contact lenses.
本研究旨在评估 Keraring 植入联合同期地形引导性光性角膜切削术（TGPRK）和角膜交联术（CXL）治疗圆锥角膜的疗效和安全性。
这是一项单中心、私立诊所的回顾性研究。对不能耐受隐形眼镜的圆锥角膜患者进行 Keraring 植入，植入后 2 至 36 个月行 TGPRK 联合 CXL。主要观察指标为未矫正远视力（UDVA）、矫正远视力（CDVA）、屈光度（柱镜和球镜等效值）、角膜曲率（陡峭、最大和中央）和中央角膜厚度（CCT）。术后随访 3 至 60 个月。
共纳入 45 例患者的 57 只眼。Keraring 与 TGPRK/CXL 之间的平均时间为 6.0±6.0 个月。Keraring 植入后平均随访 28.6±20.1 个月。在 12 个月的随访中，平均 UDVA（0.94±0.49-0.35±0.23，P<0.01）、CDVA（0.39±0.26-0.17±0.15，P<0.01）、柱镜（-4.97±2.68 至-1.74±1.25，P<0.01）、陡峭角膜曲率（51.25±3.37-45.03±2.27，P<0.01）、中央角膜曲率（52.59±4.98-46.99±3.53，P<0.01）和最大角膜曲率（58.78±4.22-50.76±3.42，P<0.01）均有统计学显著改善。这些结果在 48 个月的随访中得以维持。TGPRK 后 12 个月 CCT 下降（461.84±27.46-418.94±45.62，P<0.01），60 个月时保持稳定。术后 2 只眼（3.51%）出现角膜混浊，导致 CDVA 下降；1 只眼经重复 PRK 治疗成功；1 例（1.75%）因部分 Keraring 脱出导致伤口融化，经重新定位后愈合。
对于不能耐受隐形眼镜的圆锥角膜患者，Keraring 植入联合同期 TGPRK 和 CXL 长期疗效良好，可改善 UDVA、CDVA、柱镜、CCT 和角膜曲率。
