Lokman Hekim University, Akay Hospital, Clinic of Ophthalmology, Ankara, Türkiye
Ankara Yıldırım Beyazıt University Faculty of Medicine, Department of Ophthalmology, Ankara, Türkiye
Turk J Ophthalmol. 2024 Jun 28;54(3):120-126. doi: 10.4274/tjo.galenos.2024.82342. Epub 2024 Jun 10.
To investigate the clinical efficacy and safety of the modified Cretan protocol in patients with post-laser in situ keratomileusis ectasia (PLE).
In this retrospective study, 26 eyes of 16 patients with PLE were treated with the modified Cretan protocol (combined transepithelial phototherapeutic keratectomy and accelerated corneal collagen cross-linking). Visual, refractive, tomographic, and aberrometric outcomes and point spread function (PSF) were recorded preoperatively and at 6, 12, and 24 months after treatment.
Both uncorrected and best corrected visual acuity were stable at 24 months postoperatively compared to baseline (from 0.89±0.36 to 0.79±0.33 logarithm of the minimum angle of resolution [LogMAR] and 0.31±0.25 to 0.24±0.19 LogMAR, respectively, p>0.05 for all values). The mean K1, K2, Kmean, thinnest corneal thickness, and spherical aberration at baseline were 45.76±5.75 diopters (D), 48.62±6.17 D, 47.13±5.89 D, 433.16±56.86 μm, and -0.21±0.63 μm respectively. These values were reduced to 42.86±6.34 D, 45.92±6.74 D, 44.21±6.4 D, 391.07±54.76 μm, and -0.51±0.58 μm at 24 months postoperatively (p<0.001, p=0.002, p<0.001, p=0.001, and p=0.02, respectively). The mean spherical equivalent, manifest cylinder, Kmax, central corneal thickness, other corneal aberrations (root mean square, trefoil, coma, quatrefoil, astigmatism), and PSF remained stable (p>0.05 for all variables), while anterior and posterior elevation were significantly improved at 24 months postoperatively (p<0.001 and p=0.02, respectively). No surgical complications occurred during the 24-month follow-up.
The modified Cretan protocol is a safe and effective treatment option for PLE patients that provides visual stabilization and significant improvement in topographic parameters during the 24-month follow-up. Further studies are needed to support our results.
研究改良克里特协议在激光原位角膜磨镶术后扩张（PLE）患者中的临床疗效和安全性。
在这项回顾性研究中，16 名 PLE 患者的 26 只眼接受了改良克里特协议（经上皮准分子激光光热治疗角膜切削术联合加速角膜胶原交联）治疗。记录术前及治疗后 6、12 和 24 个月的视力、屈光、断层和像差以及点扩散函数（PSF）。
与基线相比，术后 24 个月时未矫正和最佳矫正视力均保持稳定（从最小分辨角对数视力 0.89±0.36 提高至 0.79±0.33 和从 0.31±0.25 提高至 0.24±0.19，所有值均 p>0.05）。基线时的平均 K1、K2、Kmean、最薄角膜厚度和球差分别为 45.76±5.75 屈光度（D）、48.62±6.17 D、47.13±5.89 D、433.16±56.86 μm 和-0.21±0.63 μm。术后 24 个月时，这些值分别降低至 42.86±6.34 D、45.92±6.74 D、44.21±6.4 D、391.07±54.76 μm 和-0.51±0.58 μm（p<0.001、p=0.002、p<0.001、p=0.001 和 p=0.02）。平均球镜、显式柱镜、Kmax、中央角膜厚度、其他角膜像差（均方根、三叶形、彗差、四叶形、散光）和 PSF 保持稳定（所有变量 p>0.05），而前、后表面高度在术后 24 个月时显著改善（p<0.001 和 p=0.02）。在 24 个月的随访期间，未发生手术并发症。
改良克里特协议是治疗 PLE 患者的一种安全有效的治疗选择，在 24 个月的随访期间可提供视力稳定和显著改善的地形参数。需要进一步的研究来支持我们的结果。
