Surgical control of late postkeratoplasty astigmatism with or without the use of computerized video keratography - A prospective, randomized study
Surgical control of late postkeratoplasty astigmatism with or without the use of computerized video keratography - A prospective, randomized study
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DOI：
10.1016/s0161-6420(98)91115-0
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发表时间：
1998-11-01
期刊：
影响因子：
13.7
通讯作者：
Easty, DL
中科院分区：
文献类型：
--
作者：
Karabatsas, CH;Cook, SD;Easty, DL
目的：目的：评价计算机角膜摄影术（CVK）在改进角膜移植术后散光手术设计和提高手术矫正可预测性方面的有效性。设计：一项前瞻性、对照、随机临床试验。参与者：共31只角膜移植术后患眼，分为2组（A组，16只眼; B组，15只眼），具有大于4屈光度（D）的失能性散光。所有眼均采用弧形松解切口加加压缝合的方法，A组根据地形信息制定手术计划，对照组B仅根据屈光度和角膜曲率测量获得的信息制定手术计划。主要结果测量：CVK信息引起的手术计划改变、散光、地形图模式以及与结果相关的因素。术后12个月，两组的基线散光均显著净减少（P = 0.001）。然而，两组之间的减少（A组和B组分别为47%和41%）没有显著差异。12个月时A组的地形图散光测量值为4.24 +/- 0.71 D，B组为5.60 +/- 0.51 D（P = 0.139）。12个月时，两组之间仅在角膜散光（A组3.60 +/- 0.81 D vs. B组5.77 +/- 0.52 D，P = 0.035）和屈光散光（A组2.34 +/- 0.37 D vs. B组4.88 +/- 0.52 D，P = 0.000）方面存在显著差异。A组的平均向量手术效果为91%，B组为70%。规则散光模式比不规则散光模式从手术中获益更大（P = 0.008）。先前的屈光手术与不太有利的结果（P = 0.045）。结论：目前的研究表明，使用CVK提供了一个好处相比，角膜曲率计和屈光单独的规划和手术治疗的结果高移植后散光。
Objective: To assess the effectiveness of computerized videokeratography (CVK) in refining the surgical design and in improving predictability of surgical correction of postkeratoplasty astigmatism.Design: A prospective, controlled, randomized, clinical trial.Participants: A total of 31 postkeratoplasty eyes, divided into 2 groups (group A, 16 eyes; group B, 15 eyes), with more than 4 diopters (D) of disabling astigmatism were studied.Intervention: Ail eyes were treated with a combination of arcuate relaxing incisions and compression sutures, The surgical plan in group A was based on topographic information, whereas in the control group B, the surgical plan was based on information obtained by refraction and keratometry alone.Main Outcome Measures: Change in the surgical plan induced by the CVK information, astigmatism, topographic patterns, and factors associated with outcome were measured.Results: in all 16 cases of group A, the use of CVK changed some aspect of the surgical plan. At 12 months after surgery, both groups showed a significant net reduction (P = 0.001) of baseline astigmatism. However, the reduction (47% and 41% for groups A and B, respectively) did not differ significantly between the two groups. The topographic astigmatism at 12 months measured 4.24 +/- 0.71 D in group A and 5.60 +/- 0.51 D in group B (P = 0.139). Significant differences between the two groups at 12 months were seen only for keratometric astigmatism (3.60 +/- 0.81 D in group A vs. 5.77 +/- 0.52 D in group B, P = 0.035) and refractive astigmatism (2.34 +/- 0.37 D in group A vs. 4.88 +/- 0.52 D in group B, P = 0.000). The mean vector surgical effect was 91% for group A and 70% for group B. Regular astigmatism patterns had a greater benefit from surgery than irregular patterns (P = 0.008). Previous refractive surgery was associated with less-favorable outcome (P = 0.045).Conclusions: The current study indicates that the use of CVK provides a benefit compared to keratometry and refraction alone in the planning and outcome of surgical treatment for high postgraft astigmatism.