Τίτλος:
Four-stage procedure for keratoconus: ICRS implantation, corneal cross-linking, toric phakic intraocular lens implantation, and topography-guided Photorefractive Keratectomy
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
PURPOSE: To evaluate a four-stage combined treatment for keratoconus including intrastromal corneal ring segment (ICRS) implantation followed by corneal cross-linking (CXL), toric phakic intraocular lens (IOL) implantation, and topography-guided photorefractive keratectomy (TG-PRK). METHODS: In this retrospective interventional case series, 11 eyes of 7 patients with progressive keratoconus were treated with a four-stage procedure including the following: Keraring ICRS (Mediphacos Ltda, Belo Horizonte, Brazil) implantation followed by CXL, phakic IOL implantation, and TG-PRK (minimum 6 months between each stage). Minimum follow-up was 12 months after TG-PRK. RESULTS: Both mean uncorrected distance visual acuity and corrected distance visual acuity (CDVA) improved from 0.025 decimal (20/800 Snellen) and 0.093 decimal (20/215 Snellen) preoperatively to 0.68 decimal (20/30 Snellen) and 0.73 decimal (20/27 Snellen), respectively, after the combined treatment (P < .0001). Mean postoperative CDVA of 0.73 decimal (20/27 Snellen) was similar to preoperative contact lens CDVA of 0.72 decimal (20/28 Snellen). Mean manifest refraction spherical equivalent reduced from 16.78 ± 3.58 to 0.59 ± 0.89 diopters (P < .0001) and mean refractive astigmatism reduced from 5.16 ± 1.86 to 0.82 ± 0.28 diopters (P < .0001). CONCLUSIONS: This four-stage procedure appears to be an effective and safe approach for corneal stabilization and improvement of functional vision in patients with keratoconus. Larger case series with a longer follow-up are required to thoroughly evaluate the efficacy, safety, and stability of this combined approach.
Συγγραφείς:
Coskunseven, E.
Sharma, D.P.
Grentzelos, M.A.
Sahin, O.
Kymionis, G.D.
Pallikaris, I.
Περιοδικό:
Journal of Refractive Surgery
Εκδότης:
SLACK Incorporated
Λέξεις-κλειδιά:
mitomycin; collagen; cross linking reagent; photosensitizing agent; riboflavin, adult; Article; astigmatism; case study; clinical article; clinical effectiveness; cornea disease; corneal cross linking; corneal haze; corrected distance visual acuity; cross linking; eye refraction; female; follow up; human; keratoconus; lens implantation; male; patient safety; photorefractive keratectomy; postoperative period; preoperative period; priority journal; retrospective study; surgical technique; topography; topography guided photorefractive keratectomy; treatment outcome; visual acuity; disease exacerbation; excimer laser; keratoconus; keratometry; pathophysiology; phakic intraocular lens; photorefractive keratectomy; procedures; prosthesis design; therapeutic use; time factor; ultraviolet radiation; young adult, Adult; Collagen; Corneal Topography; Cross-Linking Reagents; Disease Progression; Female; Follow-Up Studies; Humans; Keratoconus; Lasers, Excimer; Male; Phakic Intraocular Lenses; Photorefractive Keratectomy; Photosensitizing Agents; Prosthesis Design; Refraction, Ocular; Retrospective Studies; Riboflavin; Time Factors; Treatment Outcome; Ultraviolet Rays; Visual Acuity; Young Adult
DOI:
10.3928/1081597X-20170807-01
