●AIM:To explore the clinical efficacy and safety of stromal lenticule addition keratoplasty(SLAK)with corneal crosslinking(CXL)on patients with corneal ectasia secondary to femtosecond laser-assisted in situ keratomi...●AIM:To explore the clinical efficacy and safety of stromal lenticule addition keratoplasty(SLAK)with corneal crosslinking(CXL)on patients with corneal ectasia secondary to femtosecond laser-assisted in situ keratomileusis(FS-LASIK).●METHODS:A series of 5 patients undertaking SLAK with CXL for the treatment of corneal ectasia secondary to FS-LASIK were followed for 4-9mo.The lenticules were collected from patients undertaking small incision lenticule extraction(SMILE)for the correction of myopia.Adding a stromal lenticule was aimed at improving the corneal thickness for the safe application of crosslinking and compensating for the thin cornea to improve its mechanical strength.●RESULTS:All surgeries were conducted successfully with no significant complications.Their best corrected visual acuity(BCVA)ranged from 0.05 to 0.8-2 before surgery.The pre-operational total corneal thickness ranged from 345-404μm and maximum keratometry(Kmax)ranged from 50.8 to 86.3.After the combination surgery,both the corneal keratometry(range 55.9 to 92.8)and total corneal thickness(range 413-482μm)significantly increased.Four out of 5 patients had improvement of corneal biomechanical parameters(reflected by stiffness parameter A1 in Corvis ST).However,3 patients showed decreased BCVA after surgery due to the development of irregular astigmatism and transient haze.Despite the onset of corneal edema right after SLAK,the corneal topography and thickness generally stabilized after 3mo.●CONCLUSION:SLAK with CXL is a potentially beneficial and safe therapy for advanced corneal ectasia.Future work needs to address the poor predictability of corneal refractometry and compare the outcomes of different surgical modes.展开更多
AIM:To investigate tomographic features of late corneal ectasia after keratoplasty for keratoconus and compare penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in terms of incidence,time of ons...AIM:To investigate tomographic features of late corneal ectasia after keratoplasty for keratoconus and compare penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in terms of incidence,time of onset and risk factors of corneal ectasia.METHODS:Sixty eyes with PK and 30 eyes with DALK operated between 1999 and 2021 were analyzed.Final Pentacam scans were evaluated together with vision and previous topographies.Main outcome measures were vision,K values,apparent thinning on graft-host cornea and the difference between opposing quadrants in the thinnest point measurements.Anterior segment optic coherence tomography was performed for further evaluation.RESULTS:Mean follow-up was 127.2mo(24–282mo)in PK,and 64.3mo(24–144mo)in DALK.K max was higher in DALK(60.6 vs 56.7 D,P=0.012).Inferior recipient was thinner(595.9μm)in PK than DALK(662.2μm,P=0.021),due to longer follow-up.Overall corneal ectasia rate was 20.0% within 24y.Ectasia rate was the same(6.7%)in DALK 2/30 and in PK 4/60 in 10y and 13.3%in 12y(4/30 and 8/60,respectively).It increased to 23.3%(14/60)in PK over 24y.While ectasia was not seen before 7y in PK,it could be seen in DALK starting from the 5^(th) year.The intervals between keratoplasty and ectasia were 144.5mo in PK and 99mo in DALK.Inferior recipient was significantly thinner in 18 eyes with ectasia(502.7μm)compared to 76 non-ectasia(649.1μm,P=0.000).Inferior graft was thinner(561.0 vs 620.4μm,P=0.006),K max(63.3 vs 56.5 D,P=0.000),and anterior elevation was higher in ectasia(89.1 vs 48.6μm,P=0.002).Accelerated crosslinking was performed on 5 eyes.CONCLUSION:Inferior-superior recipient and inferior graft thinning on tomography,with high K max and anterior elevation emerge as the most reliable criteria for the diagnosis of late ectasia.The incidence of corneal ectasia increases with the time.展开更多
AIM：To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment（ICRS） with 140-degrees of arc in eyes with corneal ectasia.METHODS：We evaluated patients with cor...AIM：To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment（ICRS） with 140-degrees of arc in eyes with corneal ectasia.METHODS：We evaluated patients with corneal ectasia implanted with Ferrara 140° ICRS from April 2010 to February 2015.Outcome measures included preoperative and postoperative corrected distance visual acuity（CDVA）,keratometry simulated（K） reading,tomographic astigmatism and asphericity.All patients were evaluated using the Pentacam Scheimpflug system.RESULTS：The study evaluated 58 eyes.The mean followup was 16.81±10.8 mo.The CDVA（logM AR） improved from 0.5±0.20（20/60） to 0.3±0.21（20/40）（P〈0.01）.The average K reduced from 49.87±7.01 to 47.34±4.90 D（P〈0.01）.The asphericity changed from-0.60±0.86 to-0.23±0.67 D（P〈0.01）.The mean preoperative tomographic astigmatism decreased from-8.0±3.45 to-4.53±2.52 D（P〈0.01）.CONCLUSION：The new ICRS model with 140-degrees of arc effectively improve the visual acuity and reduce the high astigmatism usually found in patients with corneal ectasia.展开更多
Dear Editor,We write to describe two cases of corneal ectasia occurred after photorefractive keratectomy.Due to the wide diffusion of refractive surgery,many ophthalmologists attempted to identify the risk factors and...Dear Editor,We write to describe two cases of corneal ectasia occurred after photorefractive keratectomy.Due to the wide diffusion of refractive surgery,many ophthalmologists attempted to identify the risk factors and prevention methods to avoid such severe complication of this technique.展开更多
Citation：O’Brart D.Comment on＂Post photorefractive keratectomy corneal ectasia＂.Int J Ophthalmol 2018;11（4）：705-708Dear Editor,It is with interest that I read this paper[1]of two patients with ectasia after pho...Citation：O’Brart D.Comment on＂Post photorefractive keratectomy corneal ectasia＂.Int J Ophthalmol 2018;11（4）：705-708Dear Editor,It is with interest that I read this paper[1]of two patients with ectasia after photorefractive keratectomy（PRK）,展开更多
<strong>Purpose:</strong> To determine the diagnostic value of the anterior segment optical coherence tomography (AS-OCT) indices in differentiating normal from ectatic corneas. <strong>Material and ...<strong>Purpose:</strong> To determine the diagnostic value of the anterior segment optical coherence tomography (AS-OCT) indices in differentiating normal from ectatic corneas. <strong>Material and Methods:</strong> Two groups of patients—with corneal ectasia and normal controls were compared. Each group consists of 80 eyes of 43 age and sex-matched patients. All of them underwent corneal topography with OCULUS Keratograph 5M and corneal pachymetry with AS-OCT with RTVue-100. The indices generated by the AS-OCT pachymetric scans were analyzed. <strong>Results:</strong> There was a statistically significant difference for all the examined indices between the two groups with p values <0.001 and a confidence interval of 95%. The minimal corneal thickness (Min) was the best performing index according to the ROC analysis with an area under the curve of 0.976 and a combination of sensitivity and specificity of 0.925 and 0.911 respectively, and a “cut-off” value of 484 microns, followed by the indices of focal thinning—Min-Med and Min-Max with an area under the curve of 0.973 and 0.971 and sensitivity/specificity of 0.938/0.962 and 0.938/0.937 respectively. The rest of the examined parameters had an area under the curve in the range between 0.950 for the central corneal thickness and 0.814 for the outer superior segment. <strong>Conclusion:</strong> The anterior segment OCT indices showed excellent capability in differentiating ectatic from normal corneas.展开更多
●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were i...●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were included in this retrospective study.Patients were allocated into three groups based on the preoperative spherical equivalent(SE):low myopia(SE≥-3.00 D),moderate myopia(-3.00 D>SE>-6.00 D)and high myopia(SE≤-6.00 D).Posterior corneal surfaces were measured by a Scheimpflug camera preoperatively and different postoperative times(1wk,1,3,6mo,and 1y).Posterior mean elevation(PME)at 25 predetermined points of 3 concentric circles(2-,4-,and 6-mm diameter)above the best fit sphere was analyzed.●RESULTS:All surgeries were completed uneventfully and no ectasia was found through the observation.The difference of myopia group was significant at the 2-mm ring at 1 and 3mo postoperatively(1mo:P=0.017;3mo:P=0.018).The effect of time onΔPME was statistically significant(2-mm ring:P=0.001;4-mm ring:P<0.001;6-mm ring:P<0.001).The effect of different corneal locations onΔPME was significant except 1wk postoperatively(1mo:P=0.000;3mo:P=0.000;6mo:P=0.001;1y:P=0.001).Posterior corneal stability was linearly correlated with SE,central corneal thickness,ablation depth,residual bed thickness,percent ablation depth and percent stromal bed thickness.●CONCLUSION:The posterior corneal surface changes dynamically after SMILE.No protrusion is observed on the posterior corneal surface in patients with different degrees of myopia within one year after surgery.SMILE has good stability,accuracy,safety and predictability.展开更多
AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Total...AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Totally 120 eyes of 83 patients scheduled to receive either standard CXL(3 m W/cm^2 for a period of 30 min) or accelerated CXL(18 m W/cm2 for a period of 5 min). The main outcomes for comparison were the change in: maximum-K reading(K-max), manifest refractive spherical equivalent(SE), central corneal thickness(CCT), and the best corrected distance visual acuity(CDVA).RESULTS: One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12 mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12 mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group.CONCLUSION: Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.展开更多
This study was designed to evaluate efficacy and stability of corneal collagen crosslinking(CXL) in halting the progression of post-laser in situ keratomileusis(LASIK) ectasia and provide long-term follow-up results w...This study was designed to evaluate efficacy and stability of corneal collagen crosslinking(CXL) in halting the progression of post-laser in situ keratomileusis(LASIK) ectasia and provide long-term follow-up results with an average of 80 mo. Patients with post-LASIK ectasia were treated with CXL between December 2007 and January 2012. Main outcome measures were uncorrected distance visual acuities(UDVA) and corrected distance visual acuities(CDVA), minimum and maximum keratometry(K) values, spherical and cylindrical refraction, and corneal thickness. The study evaluated 17 eyes for 13 patients(8 men, 5 women) with mean age of 31y(range 23 to 39) and mean follow-up of 80.7±15(range 57 to 102)mo. UDVA and CDVA improved from logMAR 0.53±0.36(20/63) to 0.49±0.4(20/50)(P=0.43) and from 0.18±0.17(20/28) to 0.16±0.16(20/27)(P=0.55) respectively. In 15 eyes UDVA and in 13 eyes CDVA either remained stable or improved ≥1 Snellen lines(88.2%) and(76.5%) respectively. Although statistically insignificant, spherical and cylindrical refraction decreased post-CXL from-1.26±2.87 to-0.38±2.32 diopters(D)(P=0.054) and from-3.80±2.47 to-3.04±2.18 D(P=0.13) respectively. Kmax significantly decreased from 44.23±3.76 to 42.85±3.08 D(P=0.013) and Kmin decreased from 41.07±3.61 to 40.00±2.65 D(P=0.057). Corneal thickness decreased from 470±42 to 460±41 μm, but was statistically non-significant(P=0.063). Therefore, CXL is effective in halting and partially reversing the progression of postLASIK ectasia on the long-term(mean follow-up of more than 80mo), thus highlighting the stability and maintained effect of CXL for such cases.展开更多
AIM:To compare the safety and efficacy of conventional versus accelerated(9 mW/cm^2)corneal collagen crosslinking(CXL)in progressive keratoconus at the 2-year follow-up.METHODS:In this prospective study,consecutive pr...AIM:To compare the safety and efficacy of conventional versus accelerated(9 mW/cm^2)corneal collagen crosslinking(CXL)in progressive keratoconus at the 2-year follow-up.METHODS:In this prospective study,consecutive progressive keratoconus patients were randomized to receive either conventional CXL(CCXL)or accelerated CXL(ACXL;using hydroxypropyl methylcellulose-assisted riboflavin imbibition for 10 min at 9 mW/cm^2).Visual,refractive,keratometric,topographic,and aberrometric outcomes and stromal demarcation line depth(DLD)measurements were compared at the end of a 2-year follow-up.RESULTS:Thirty-two eyes from 32 patients in the CCXL and 27 eyes from 27 patients in the ACXL groups completed 2-year follow-up.At 2y post-CXL,both uncorrected and corrected visual acuities improved significantly in both groups.The improvements in keratometric readings,flattening rate(flattening of the maximum keratometry more than 1 D),3 topographic indices,and vertical coma were significantly better in the CCXL group compared to the ACXL group(P<0.05).The DLD as measured by anterior segment optical coherence tomography or in vivo confocal microscopy was better detectable and significantly deeper in the CCXL group compared to the ACXL group.The deeper DLD was found to be significantly correlated with improvements in the mean keratometry measurements.Progression was noted in 11.1%of eyes in the ACXL group,whereas progression was not observed in any patient eye in the CCXL group.CONCLUSION:In this prospective randomized study,ACXL is less effective in halting the progression of keratoconus at a 2-year follow-up compared to CCXL.展开更多
AIM： To evaluate the visual, refractive and corneal asphericity changes after intrastromal corneal ring segment（ICRS） implantation for visual rehabilitation of keratoconus.METHODS： A total of 42 eyes of 32 patient...AIM： To evaluate the visual, refractive and corneal asphericity changes after intrastromal corneal ring segment（ICRS） implantation for visual rehabilitation of keratoconus.METHODS： A total of 42 eyes of 32 patients were included. After creation of intrastromal tunnels of 5.01±0.03 mm inner diameter, 5.71±0.03 mm outer diameter and at 384.21±34.12 μm depth, 1 or 2 ICRS of 150-300 μm thickness and 90°-210° arc length were implanted. Changes in uncorrected distance visual acuity（UDVA）, corrected distance visual acuity（CDVA）, refractive errors, mean simulated keratometry readings SimK_（avg）, anterior and posterior corneal asphericity values（Q_（ant） and Q_（post）, respectively） measured with Scheimpflug topography were evaluated retrospectively. RESULTS： There was a significant improvement in UDVA and CDVA, along with a significant decrease in refractive spherical equivalent（SE）, cylinder and SimK_（avg） postoperatively（P〈0.001 for all）. Mean Qant increased from-1.06±0.48 to-0.57±0.58 postoperatively（P〈0.001）. Change in mean Qpost was insignificant（P=0.92）. Postoperative changes in UDVA and CDVA were not correlated with the postoperative changes in SE and cylinder（P〉0.05 for all）; but were correlated with the preoperative SimK_（avg） and Q_（ant） values（P〈0.001 for all）. CONCLUSION： ICRS implantation seems to approximate the anterior corneal asphericity of ＂advanced prolate＂ shape to ＂optimal prolate＂ shape and an ＂ideal Q value＂ of-0.46; which may have a role in improved UDVA and CDVA postoperatively, besides decreased refractive cylinder values.展开更多
基金Supported by the Science&Technology Department of Sichuan Province(China)Funding Project(No.2021YFS0221,No.2023YFS0179)1.3.5 Project for Disciplines of Excellence,West China Hospital,Sichuan University(No.2022HXFH032,No.ZYJC21058)the Postdoctoral Research Funding of West China Hospital,Sichuan University,China(No.2020HXBH044).
文摘●AIM:To explore the clinical efficacy and safety of stromal lenticule addition keratoplasty(SLAK)with corneal crosslinking(CXL)on patients with corneal ectasia secondary to femtosecond laser-assisted in situ keratomileusis(FS-LASIK).●METHODS:A series of 5 patients undertaking SLAK with CXL for the treatment of corneal ectasia secondary to FS-LASIK were followed for 4-9mo.The lenticules were collected from patients undertaking small incision lenticule extraction(SMILE)for the correction of myopia.Adding a stromal lenticule was aimed at improving the corneal thickness for the safe application of crosslinking and compensating for the thin cornea to improve its mechanical strength.●RESULTS:All surgeries were conducted successfully with no significant complications.Their best corrected visual acuity(BCVA)ranged from 0.05 to 0.8-2 before surgery.The pre-operational total corneal thickness ranged from 345-404μm and maximum keratometry(Kmax)ranged from 50.8 to 86.3.After the combination surgery,both the corneal keratometry(range 55.9 to 92.8)and total corneal thickness(range 413-482μm)significantly increased.Four out of 5 patients had improvement of corneal biomechanical parameters(reflected by stiffness parameter A1 in Corvis ST).However,3 patients showed decreased BCVA after surgery due to the development of irregular astigmatism and transient haze.Despite the onset of corneal edema right after SLAK,the corneal topography and thickness generally stabilized after 3mo.●CONCLUSION:SLAK with CXL is a potentially beneficial and safe therapy for advanced corneal ectasia.Future work needs to address the poor predictability of corneal refractometry and compare the outcomes of different surgical modes.
文摘AIM:To investigate tomographic features of late corneal ectasia after keratoplasty for keratoconus and compare penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in terms of incidence,time of onset and risk factors of corneal ectasia.METHODS:Sixty eyes with PK and 30 eyes with DALK operated between 1999 and 2021 were analyzed.Final Pentacam scans were evaluated together with vision and previous topographies.Main outcome measures were vision,K values,apparent thinning on graft-host cornea and the difference between opposing quadrants in the thinnest point measurements.Anterior segment optic coherence tomography was performed for further evaluation.RESULTS:Mean follow-up was 127.2mo(24–282mo)in PK,and 64.3mo(24–144mo)in DALK.K max was higher in DALK(60.6 vs 56.7 D,P=0.012).Inferior recipient was thinner(595.9μm)in PK than DALK(662.2μm,P=0.021),due to longer follow-up.Overall corneal ectasia rate was 20.0% within 24y.Ectasia rate was the same(6.7%)in DALK 2/30 and in PK 4/60 in 10y and 13.3%in 12y(4/30 and 8/60,respectively).It increased to 23.3%(14/60)in PK over 24y.While ectasia was not seen before 7y in PK,it could be seen in DALK starting from the 5^(th) year.The intervals between keratoplasty and ectasia were 144.5mo in PK and 99mo in DALK.Inferior recipient was significantly thinner in 18 eyes with ectasia(502.7μm)compared to 76 non-ectasia(649.1μm,P=0.000).Inferior graft was thinner(561.0 vs 620.4μm,P=0.006),K max(63.3 vs 56.5 D,P=0.000),and anterior elevation was higher in ectasia(89.1 vs 48.6μm,P=0.002).Accelerated crosslinking was performed on 5 eyes.CONCLUSION:Inferior-superior recipient and inferior graft thinning on tomography,with high K max and anterior elevation emerge as the most reliable criteria for the diagnosis of late ectasia.The incidence of corneal ectasia increases with the time.
文摘AIM：To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment（ICRS） with 140-degrees of arc in eyes with corneal ectasia.METHODS：We evaluated patients with corneal ectasia implanted with Ferrara 140° ICRS from April 2010 to February 2015.Outcome measures included preoperative and postoperative corrected distance visual acuity（CDVA）,keratometry simulated（K） reading,tomographic astigmatism and asphericity.All patients were evaluated using the Pentacam Scheimpflug system.RESULTS：The study evaluated 58 eyes.The mean followup was 16.81±10.8 mo.The CDVA（logM AR） improved from 0.5±0.20（20/60） to 0.3±0.21（20/40）（P〈0.01）.The average K reduced from 49.87±7.01 to 47.34±4.90 D（P〈0.01）.The asphericity changed from-0.60±0.86 to-0.23±0.67 D（P〈0.01）.The mean preoperative tomographic astigmatism decreased from-8.0±3.45 to-4.53±2.52 D（P〈0.01）.CONCLUSION：The new ICRS model with 140-degrees of arc effectively improve the visual acuity and reduce the high astigmatism usually found in patients with corneal ectasia.
文摘Dear Editor,We write to describe two cases of corneal ectasia occurred after photorefractive keratectomy.Due to the wide diffusion of refractive surgery,many ophthalmologists attempted to identify the risk factors and prevention methods to avoid such severe complication of this technique.
文摘Citation：O’Brart D.Comment on＂Post photorefractive keratectomy corneal ectasia＂.Int J Ophthalmol 2018;11（4）：705-708Dear Editor,It is with interest that I read this paper[1]of two patients with ectasia after photorefractive keratectomy（PRK）,
文摘<strong>Purpose:</strong> To determine the diagnostic value of the anterior segment optical coherence tomography (AS-OCT) indices in differentiating normal from ectatic corneas. <strong>Material and Methods:</strong> Two groups of patients—with corneal ectasia and normal controls were compared. Each group consists of 80 eyes of 43 age and sex-matched patients. All of them underwent corneal topography with OCULUS Keratograph 5M and corneal pachymetry with AS-OCT with RTVue-100. The indices generated by the AS-OCT pachymetric scans were analyzed. <strong>Results:</strong> There was a statistically significant difference for all the examined indices between the two groups with p values <0.001 and a confidence interval of 95%. The minimal corneal thickness (Min) was the best performing index according to the ROC analysis with an area under the curve of 0.976 and a combination of sensitivity and specificity of 0.925 and 0.911 respectively, and a “cut-off” value of 484 microns, followed by the indices of focal thinning—Min-Med and Min-Max with an area under the curve of 0.973 and 0.971 and sensitivity/specificity of 0.938/0.962 and 0.938/0.937 respectively. The rest of the examined parameters had an area under the curve in the range between 0.950 for the central corneal thickness and 0.814 for the outer superior segment. <strong>Conclusion:</strong> The anterior segment OCT indices showed excellent capability in differentiating ectatic from normal corneas.
基金Supported by Shandong Provincial Natural Science Foundation(No.ZR2022QH384).
文摘●AIM:To study the changes and effect factors of posterior corneal surface after small incision lenticule extraction(SMILE)with different myopic diopters.●METHODS:Ninety eyes of 90 patients who underwent SMILE were included in this retrospective study.Patients were allocated into three groups based on the preoperative spherical equivalent(SE):low myopia(SE≥-3.00 D),moderate myopia(-3.00 D>SE>-6.00 D)and high myopia(SE≤-6.00 D).Posterior corneal surfaces were measured by a Scheimpflug camera preoperatively and different postoperative times(1wk,1,3,6mo,and 1y).Posterior mean elevation(PME)at 25 predetermined points of 3 concentric circles(2-,4-,and 6-mm diameter)above the best fit sphere was analyzed.●RESULTS:All surgeries were completed uneventfully and no ectasia was found through the observation.The difference of myopia group was significant at the 2-mm ring at 1 and 3mo postoperatively(1mo:P=0.017;3mo:P=0.018).The effect of time onΔPME was statistically significant(2-mm ring:P=0.001;4-mm ring:P<0.001;6-mm ring:P<0.001).The effect of different corneal locations onΔPME was significant except 1wk postoperatively(1mo:P=0.000;3mo:P=0.000;6mo:P=0.001;1y:P=0.001).Posterior corneal stability was linearly correlated with SE,central corneal thickness,ablation depth,residual bed thickness,percent ablation depth and percent stromal bed thickness.●CONCLUSION:The posterior corneal surface changes dynamically after SMILE.No protrusion is observed on the posterior corneal surface in patients with different degrees of myopia within one year after surgery.SMILE has good stability,accuracy,safety and predictability.
文摘AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Totally 120 eyes of 83 patients scheduled to receive either standard CXL(3 m W/cm^2 for a period of 30 min) or accelerated CXL(18 m W/cm2 for a period of 5 min). The main outcomes for comparison were the change in: maximum-K reading(K-max), manifest refractive spherical equivalent(SE), central corneal thickness(CCT), and the best corrected distance visual acuity(CDVA).RESULTS: One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12 mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12 mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group.CONCLUSION: Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.
文摘This study was designed to evaluate efficacy and stability of corneal collagen crosslinking(CXL) in halting the progression of post-laser in situ keratomileusis(LASIK) ectasia and provide long-term follow-up results with an average of 80 mo. Patients with post-LASIK ectasia were treated with CXL between December 2007 and January 2012. Main outcome measures were uncorrected distance visual acuities(UDVA) and corrected distance visual acuities(CDVA), minimum and maximum keratometry(K) values, spherical and cylindrical refraction, and corneal thickness. The study evaluated 17 eyes for 13 patients(8 men, 5 women) with mean age of 31y(range 23 to 39) and mean follow-up of 80.7±15(range 57 to 102)mo. UDVA and CDVA improved from logMAR 0.53±0.36(20/63) to 0.49±0.4(20/50)(P=0.43) and from 0.18±0.17(20/28) to 0.16±0.16(20/27)(P=0.55) respectively. In 15 eyes UDVA and in 13 eyes CDVA either remained stable or improved ≥1 Snellen lines(88.2%) and(76.5%) respectively. Although statistically insignificant, spherical and cylindrical refraction decreased post-CXL from-1.26±2.87 to-0.38±2.32 diopters(D)(P=0.054) and from-3.80±2.47 to-3.04±2.18 D(P=0.13) respectively. Kmax significantly decreased from 44.23±3.76 to 42.85±3.08 D(P=0.013) and Kmin decreased from 41.07±3.61 to 40.00±2.65 D(P=0.057). Corneal thickness decreased from 470±42 to 460±41 μm, but was statistically non-significant(P=0.063). Therefore, CXL is effective in halting and partially reversing the progression of postLASIK ectasia on the long-term(mean follow-up of more than 80mo), thus highlighting the stability and maintained effect of CXL for such cases.
文摘AIM:To compare the safety and efficacy of conventional versus accelerated(9 mW/cm^2)corneal collagen crosslinking(CXL)in progressive keratoconus at the 2-year follow-up.METHODS:In this prospective study,consecutive progressive keratoconus patients were randomized to receive either conventional CXL(CCXL)or accelerated CXL(ACXL;using hydroxypropyl methylcellulose-assisted riboflavin imbibition for 10 min at 9 mW/cm^2).Visual,refractive,keratometric,topographic,and aberrometric outcomes and stromal demarcation line depth(DLD)measurements were compared at the end of a 2-year follow-up.RESULTS:Thirty-two eyes from 32 patients in the CCXL and 27 eyes from 27 patients in the ACXL groups completed 2-year follow-up.At 2y post-CXL,both uncorrected and corrected visual acuities improved significantly in both groups.The improvements in keratometric readings,flattening rate(flattening of the maximum keratometry more than 1 D),3 topographic indices,and vertical coma were significantly better in the CCXL group compared to the ACXL group(P<0.05).The DLD as measured by anterior segment optical coherence tomography or in vivo confocal microscopy was better detectable and significantly deeper in the CCXL group compared to the ACXL group.The deeper DLD was found to be significantly correlated with improvements in the mean keratometry measurements.Progression was noted in 11.1%of eyes in the ACXL group,whereas progression was not observed in any patient eye in the CCXL group.CONCLUSION:In this prospective randomized study,ACXL is less effective in halting the progression of keratoconus at a 2-year follow-up compared to CCXL.
文摘AIM： To evaluate the visual, refractive and corneal asphericity changes after intrastromal corneal ring segment（ICRS） implantation for visual rehabilitation of keratoconus.METHODS： A total of 42 eyes of 32 patients were included. After creation of intrastromal tunnels of 5.01±0.03 mm inner diameter, 5.71±0.03 mm outer diameter and at 384.21±34.12 μm depth, 1 or 2 ICRS of 150-300 μm thickness and 90°-210° arc length were implanted. Changes in uncorrected distance visual acuity（UDVA）, corrected distance visual acuity（CDVA）, refractive errors, mean simulated keratometry readings SimK_（avg）, anterior and posterior corneal asphericity values（Q_（ant） and Q_（post）, respectively） measured with Scheimpflug topography were evaluated retrospectively. RESULTS： There was a significant improvement in UDVA and CDVA, along with a significant decrease in refractive spherical equivalent（SE）, cylinder and SimK_（avg） postoperatively（P〈0.001 for all）. Mean Qant increased from-1.06±0.48 to-0.57±0.58 postoperatively（P〈0.001）. Change in mean Qpost was insignificant（P=0.92）. Postoperative changes in UDVA and CDVA were not correlated with the postoperative changes in SE and cylinder（P〉0.05 for all）; but were correlated with the preoperative SimK_（avg） and Q_（ant） values（P〈0.001 for all）. CONCLUSION： ICRS implantation seems to approximate the anterior corneal asphericity of ＂advanced prolate＂ shape to ＂optimal prolate＂ shape and an ＂ideal Q value＂ of-0.46; which may have a role in improved UDVA and CDVA postoperatively, besides decreased refractive cylinder values.
