Intacs for keratoconus
Intacs for keratoconus
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DOI：
10.1016/s0161-6420(03)00094-0
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发表时间：
2003-05-01
期刊：
影响因子：
13.7
通讯作者：
Christie, JP
中科院分区：
文献类型：
--
作者：
Wachler, BSB;Chandra, NS;Christie, JP
目的：评估圆锥角膜受试者植入 Intacs 的有效性和安全性。设计：回顾性、非随机比较试验。干预：基质内角膜环段植入。参与者：对 50 名受试者（41 名男性和 9 名女性）的 74 只眼睛进行了评估。研究对象的平均年龄为 35 岁，范围从 20 岁到 73 岁。 26 名受试者接受了单眼治疗，24 名受试者接受了双眼治疗。 方法：对圆锥角膜受试者进行改良的 Intacs 手术。在切口部位测量厚度，切口在角膜厚度的66%处进行。根据屈光列线图，通常将较厚的环段放置在下方，将较薄的环段放置在上方。 主要结果指标：术前和术后裸眼视力、最佳眼镜矫正视力和球镜等效值之间的差异。用角膜地形图的上下值评估不规则散光的变化，并研究屈光柱镜组的差异。结果：术前平均最佳矫正最小分辨角对数 (LogMAR) 视力为 0.41 (20/50 - 1)（标准差 [SD], +/-0.48），术后平均值改善为 0.24 (20/32 - 2) （SD，+/-0.31）（两条改进线）。术前平均未矫正 LogMAR 视力为 1.05 (20/200 - 2 1) (SD, +/-0.48)，术后随访时平均改善至 0.61 (20/80-) (SD, +/-0.52)（四行改善）。角膜疤痕组术前平均最佳校正 LogMAR 视力为 0.96 (20/200 + 2) (SD, +/-0.72)，改善至平均值 0.54 (SD, +/-0.43) (20/63 - 2)（改善了 5 行）。角膜疤痕眼睛的未校正平均 LogMAR 敏锐度为 1.42 (20/400 - 4) (SD, +/-0.27)，改善至平均值 1.03 (20/200 - 1) (SD, +/-73)（三行改善）。术前平均等效球镜为 -3.89 屈光度 (D) (SD, +/-5.16)，术后随访时平均等效球镜度数为 -1.46 D (+/-4.11)。 结论：不对称 Intacs 植入可提高裸眼视力和最佳眼镜矫正视力，并可减少有或无角膜疤痕的角膜不规则散光。
Purpose: To evaluate the efficacy and safety of placement of Intacs in subjects with keratoconus.Design: Retrospective, nonrandomized comparative trial.Intervention: Intrastromal corneal ring segment implantation.Participants: Seventy-four eyes of 50 subjects (41 male and 9 female) were evaluated. The mean age of subjects in the study was 35 years, ranging from 20 to 73 years. Twenty-six subjects underwent single-eye treatment, and 24 subjects had both eyes treated.Methods: A modified Intacs procedure was performed on subjects with keratoconus. Pachymetry was measured at the incision site, and the incision was made at 66% of the corneal thickness. A thicker ring segment was typically placed inferiorly, and a thinner segment was placed superiorly on the basis of a refractive nomogram.Main Outcome Measures: Differences between preoperative and postoperative uncorrected visual acuity, best spectacle-corrected acuity, and spherical equivalent. Changes in irregular astigmatism were evaluated with the inferior-superior value from comeotopographic maps, and differences in refractive cylinder groups were studied.Results: Preoperative mean best-corrected logarithm of the minimum angle of resolution (LogMAR) visual acuity was 0.41 (20/50 - 1) (standard deviation [SD], +/-0.48), which improved to a postoperative mean of 0.24 (20/32 - 2) (SD, +/-0.31) (two lines of improvement). Preoperative mean uncorrected LogMAR visual acuity was 1.05 (20/200 - 2 1) (SD, +/-0.48), which improved to a mean of 0.61 (20/80-) (SD, +/-0.52) (four lines of improvement) at postoperative follow-up. Preoperative mean best-corrected LogMAR acuity in the corneal scarring group was 0.96 (20/200 + 2) (SD, +/-0.72), which improved to a mean of 0.54 (SD, +/-0.43) (20/63 - 2) (five lines of improvement). Uncorrected mean LogMAR acuity in the eyes with corneal scarring was 1.42 (20/400 - 4) (SD, +/-0.27), which improved to a mean of 1.03 (20/200 - 1) (SD, +/-73) (three lines of improvement). The mean spherical equivalent before surgery was -3.89 diopters (D) (SD, +/-5.16), which was reduced to a mean of -1.46 D (+/-4.11) at the postoperative follow-up.Conclusions: Asymmetric Intacs implantation can improve both uncorrected and best spectacle-corrected visual acuity and can reduce irregular astigmatism in corneas with and without corneal scarring.