Four-Stage Procedure for Keratoconus: ICRS Implantation, Corneal Cross-linking, Toric Phakic Intraocular Lens Implantation, and Topography-Guided Photorefractive Keratectomy
| Autor: | Ioannis G. Pallikaris, George D. Kymionis, Efekan Coskunseven, Michael A. Grentzelos, Onurcan Sahin, Daya Papalkar Sharma |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Phakic Intraocular Lenses Keratoconus medicine.medical_specialty Time Factors Visual acuity genetic structures Ultraviolet Rays Riboflavin medicine.medical_treatment Visual Acuity Astigmatism Prosthesis Design Refraction Ocular Phakic intraocular lens Photorefractive Keratectomy Young Adult 03 medical and health sciences 0302 clinical medicine Ophthalmology medicine Humans Retrospective Studies Photosensitizing Agents Intrastromal corneal ring segment medicine.diagnostic_test business.industry Corneal Topography medicine.disease Corneal topography eye diseases Photorefractive keratectomy Contact lens Cross-Linking Reagents Treatment Outcome Disease Progression 030221 ophthalmology & optometry Female Lasers Excimer Surgery Collagen sense organs medicine.symptom business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Journal of Refractive Surgery. 33:683-689 |
| ISSN: | 1081-597X |
| DOI: | 10.3928/1081597x-20170807-01 |
| Popis: | 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. [ J Refract Surg. 2017;33(10):683–689.] |
| Databáze: | OpenAIRE |
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