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
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