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Possibilities of combined treatment for stage I-III keratoconus. Implantation of intrastromal corneal segments and corneal collagen cross-linking in the paired eye

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First Author: D.Mirsaitova RUSSIA

Co Author(s):    A. Titov                    

Abstract Details

Purpose:

to evaluate the effectiveness of using various sequence for the combined treatment of stage I-III keratoconus.

Setting:

The S. Fyodorov Eye Microsurgery Federal State Institution, St. Petersburg Branch

Methods:

11 men (22 eyes)aged 18 to 46 years(mean age 29.11 ± 6.86). Combined treatment of stage I-IIIkeratoconus was carried out: CXLwas performed on one eye, implantation of an ICRwas performed simultaneously on the paired eye. Clinical and functional indicators were assessed 3months postoperatively. All patients underwent visometry, autorefractometry, biomicroscopy, keratotopography, pachymetry.CXL was carried out according to a standard protocol using a Dextralink corneal protector and a corneal phototherapy Evolution manufactured by LLCTranscontac (Moscow).The corneal tunnel for ICRS implantation was formed using a Visumax® under the ICRS program mode. Intrastromal segments from polymethylmethacrylate of domestic production were used(LLC Scientifical ExperimentalProductionEye Microsurgery).

Results:

Analysis of clinical and functional indicators after CXL were following: UCVA increased from 0.11 ± 0.11 to 0.35 ± 0.22; BCVA increased from 0.67 ± 0.19 to 0.79 ± 0.22; the refractive power (Kmax) of the cornea decreased from 48.41 ± 2.26 to 46.05 ± 2.69 D; the manifest refraction and the thickness of the cornea in the keratectasia zone decreased from -1.82 ± 4.28 to -1.46 ± 2.85 D, from -5.61 ± 2.75 to -1.28 ± 2.67 D and from 468.4 ± 32.29 to 459 ± 32.71 μm. In the paired eye after ICR implantation were more significant increase in UCVA was observed (from 0.18 ± 0.12 to 0.64 ± 0.13) in the long-term follow-up period; BCVA increased from 0.64 ± 0.15 to 0.86 ± 0.15; the refractive power of the cornea (Kmax) decreased from 49.05 ± 2.69 to 44.15 ± 2.43 D; the index of the spherical component of refraction decreased from -1.83 ± 3.39 to -0.33 ± 0.61 D; the cylindrical component of refraction decreased from -3.97 ± 1.51 to -1.05 ± 1.40 D and the thickness of the cornea in the keratectasia zone decreased from 459.50 ± 32.89 to 446.00 ± 32.66 μm.

Conclusions:

This combined treatment method allows to reduce the time of medical care for patients with stage I-III keratoconus in both eyes and makes it possible to carry out 2 stages of treatment - corneal collagen crosslinking after implantation of ICR at an earlier date (after 2-3 months). Combined treatment of keratoconus of the I-III stage allows to achieve high clinical and functional results at an earlier date (2-3 months) in comparison with standard treatment tactics.

Financial Disclosure:

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