Two-stage procedure in the management of selected cases of keratoconus: clear lens extraction with aspherical IOL implantation followed by WFG-PRK  

作　　者：Waleed Abou Samra Tharwat Mokbel Mohammed Elwan Sameh Saleh Ahmed Elwehidy Mohammed Iqbal Adel Ellayeh 

机构地区：[1]Department of Ophthalmology, Faculty of Medicine, Mansoura University [2]Department of Ophthalmology, Faculty of Medicine, Sohag University

出　　处：《International Journal of Ophthalmology(English edition)》2018年第11期1761-1767,共7页国际眼科杂志（英文版）

摘　　要：AIM： To assess the objective and subjective results of a two-stage procedure for management of keratoconus： clear lensectomy with aspherical intraocular lens（IOL） implantation followed by wave front-guided photorefractive keratotomy（WFG-PRK）.METHODS： This prospective interventional non-randomized study included patients aged 35 years old or more with grade I and II stable keratoconus, a clear visual axis, minimal corneal thickness（MCT） 420 μm or more and average keratometric reading（K） less than 54 diopter（D）. Refraction of all selected eyes should be-8.00 D sphere or more with less than-6.00 D cylinder and could be corrected two lines or more with spectacles or contact lenses. All studied eyes underwent a two-stage approach treatment： first refractive lens exchange and aspherical IOL implantation followed, after at least 3 mo, by WFGPRK. Pre and postoperative complete ophthalmological examination were performed. Topographical, visual and aberrometric results were recorded and evaluated during 6 mo follow up period. Moreover, patient satisfaction and other subjective outcomes were also analyzed.RESULTS： The 13 eyes of 11 patients diagnosed with stable keratoconus and aged from 39 to 49 y（42.4±6.2 y） were enrolled in the study. At baseline, 8 eyes had grade I and 5 eyes had grade II keratoconus. The manifest sphere was-10.3±4.2 D（ranged from-8.0 to-14.0 D） and the manifest cylinder was-4.2±1.2 D（ranged from-1.75 to-5.50 D）. After the two-stage procedure, sphere and cylinder reduced significantly to-0.43±0.22 D and-1.3±0.72 D respectively（P〈0.001）. There was also a highly significant improvement in the mean uncorrected distance visual acuity（UDVA） from logMAR 1.41±0.49 preoperatively to 0.51±0.16 postoperatively（P〈0.001） and the mean corrected distance visual acuity（CDVA） from 0.76±0.24 preoperatively to 0.49±0.13 after the operation（P〈0.001）. All aberrometric and mesopic vision parameters and most of the topographical indices demonstrateAIM： To assess the objective and subjective results of a two-stage procedure for management of keratoconus： clear lensectomy with aspherical intraocular lens（IOL） implantation followed by wave front-guided photorefractive keratotomy（WFG-PRK）.METHODS： This prospective interventional non-randomized study included patients aged 35 years old or more with grade I and II stable keratoconus, a clear visual axis, minimal corneal thickness（MCT） 420 μm or more and average keratometric reading（K） less than 54 diopter（D）. Refraction of all selected eyes should be-8.00 D sphere or more with less than-6.00 D cylinder and could be corrected two lines or more with spectacles or contact lenses. All studied eyes underwent a two-stage approach treatment： first refractive lens exchange and aspherical IOL implantation followed, after at least 3 mo, by WFGPRK. Pre and postoperative complete ophthalmological examination were performed. Topographical, visual and aberrometric results were recorded and evaluated during 6 mo follow up period. Moreover, patient satisfaction and other subjective outcomes were also analyzed.RESULTS： The 13 eyes of 11 patients diagnosed with stable keratoconus and aged from 39 to 49 y（42.4±6.2 y） were enrolled in the study. At baseline, 8 eyes had grade I and 5 eyes had grade II keratoconus. The manifest sphere was-10.3±4.2 D（ranged from-8.0 to-14.0 D） and the manifest cylinder was-4.2±1.2 D（ranged from-1.75 to-5.50 D）. After the two-stage procedure, sphere and cylinder reduced significantly to-0.43±0.22 D and-1.3±0.72 D respectively（P〈0.001）. There was also a highly significant improvement in the mean uncorrected distance visual acuity（UDVA） from logMAR 1.41±0.49 preoperatively to 0.51±0.16 postoperatively（P〈0.001） and the mean corrected distance visual acuity（CDVA） from 0.76±0.24 preoperatively to 0.49±0.13 after the operation（P〈0.001）. All aberrometric and mesopic vision parameters and most of the topographical indices demonstrate

关 键 词：KERATOCONUS clear lensectomy wave front guided photorefractive keratotomy 

分 类 号：R77[医药卫生—眼科]