Keratokonus Tedavisinin Farklı Evrelerinde Femtosaniye Lazerle KeraRing İmplantasyonu

Yıl 2024, Cilt: 7 Sayı: 3, 339 - 347, 27.10.2024

Ayşem Gül Ulukartal , Nilgün Solmaz , Önder Feyza

https://doi.org/10.53446/actamednicomedia.1515016

Öz

Amaç: Femtosaniye lazer destekli KeraRing (Mediphacos, Belo Horizonte, Brezilya) implantasyonunun keratokonus tedavisinde güvenilirliğini ve etkinliğini araştırmak.
Yöntem: Kontakt lens kullanamayan 14 hastanın 15 gözüne intrastromal korneal halka segmentleri (KeraRing, Mediphacos, Brezilya) implante edildi. Korneal tünel oluşturulması için femtosaniye lazer (Intralase, 60 Hz) kullanıldı. Korneadaki ektatik alanın dağılımına göre, 9 göze çift segment, 6 göze tek segment implante edildi. Olguların preoperatif ve postoperatif düzeltilmemiş görme keskinliği (UCVA), en iyi düzeltilmiş görme keskinliği (BCVA), objektif ve subjektif refraksiyon ile topografik korneal eğrilik (K) değerleri Wilcoxon testi kullanılarak karşılaştırıldı.
Bulgular: Hastaların ortalama yaşı 25±7.46 (aralık: 15-39) yıl olup, ortalama postoperatif takip süresi 10.8±7.37 (aralık: 1-24 ay) aydır. BCVA, takip süresi boyunca tüm gözlerde artmış, ortalama 0.12±0.1'den 0.38±0.24'e yükselmiştir (p<0.001). BCVA, 12 gözde ortalama 0.40±0.15'ten 0.55±0.23'e yükselmiş (p=0.003), 2 gözde değişmemiş ve 1 gözde 1 satır azalmıştır. Subjektif sferik refraksiyon -3.02±3.8'den -1.43±2.7'ye, subjektif silindirik refraksiyon ise -4.2±1.8'den -1.03±1.1'e düşmüştür (p<0.005). Ortalama topografik astigmatizma -5.03±2.0 D'den -3.27±2.35 D'ye (p=0.012) ve ortalama K değeri 52.6±4.7 D'den 50.35±4.4 D'ye düşmüştür (p<0.005). Postoperatif dönemde, bir vakada tünel içinde halka segmentlerinin hafif migrasyonu dışında komplikasyon gözlenmemiştir.
Sonuç: Femtosaniye lazer destekli intrakorneal halka implantasyonu, keratokonusta görsel sonuçlar açısından etkili ve güvenilir bir yöntemdir.

Anahtar Kelimeler

keraring, femtosaniye lazer, keratokonus

KeraRing Implantation with Femtosecond Laser in Keratoconus Treatment at Different Stages

Öz

Objective: To investigate the reliability and effectiveness of femtosecond laser-assisted KeraRing (Mediphacos, Belo Horizonte, Brazil) implantation in treating keratoconus.
Methods: Intrastromal corneal ring segments (KeraRing, Mediphacos, Brazil) were implanted in 15 eyes of 14 patients unable to tolerate contact lenses. Femtosecond laser (Intralase, 60 Hz) was used for corneal tunnel creation. Based on the distribution of ectatic area on the cornea, dual segments were implanted in 9 eyes, while single segments were implanted in 6 eyes. Preoperative and postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), objective and subjective refraction, and topographic corneal curvature (K) values of the cases were compared using the Wilcoxon test.
Results: The mean age of patients was 25±7.46 (range: 15-39) years, with a mean postoperative follow-up period of 10.8±7.37 (range: 1-24 months). BCVA improved in all eyes during the follow-up period, increasing from a mean of 0.12±0.1 to 0.38±0.24 (p<0.001). BCVA increased in 12 eyes, with a mean of 0.40±0.15 to 0.55±0.23 (p=0.003), remained unchanged in 2 eyes, and decreased by 1 line in 1 eye. Subjective spherical refraction decreased from -3.02±3.8 to -1.43±2.7, and subjective cylindrical refraction decreased from -4.2±1.8 to -1.03±1.1 (p<0.005). Mean topographic astigmatism decreased from -5.03±2.0 D to -3.27±2.35 D (p=0.012), and mean K value decreased from 52.6±4.7 D to 50.35±4.4 D (p<0.005). During the postoperative period, no complications were observed except for a slight migration of ring segments within the tunnel in one case.
Conclusion: Femtosecond laser-assisted intracorneal ring implantation is an effective and reliable method for visual outcomes in keratoconus.

Anahtar Kelimeler

keraring, femtosecond laser, keratoconus

Kaynakça

• Rabinowitz YS. Keratoconus. Surv Ophthalmol. Jan-Feb 1998;42(4):297-319. doi:10.1016/s0039-6257(97)00119-7
• Sray WA, Cohen EJ, Rapuano CJ, Laibson PR. Factors associated with the need for penetrating keratoplasty in keratoconus. Cornea. Nov 2002;21(8):784-6. doi:10.1097/00003226-200211000-00011
• Zadnik K, Barr JT, Edrington TB, et al. Baseline findings in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. Invest Ophthalmol Vis Sci. Dec 1998;39(13):2537-46
• Jhanji V, Sharma N, Vajpayee RB. Management of keratoconus: current scenario. Br J Ophthalmol. Aug 2011;95(8):1044-50. doi:10.1136/bjo.2010.185868
• Shabayek MH, Alio JL. Intrastromal corneal ring segment implantation by femtosecond laser for keratoconus correction. Ophthalmology. Sep 2007;114(9):1643-52. doi:10.1016/j.ophtha.2006.11.033
• Pinero DP, Alio JL. Intracorneal ring segments in ectatic corneal disease - a review. Clin Exp Ophthalmol. Mar 2010;38(2):154-67. doi:10.1111/j.1442-9071.2010.02197.x
• Kwitko S, Severo NS. Ferrara intracorneal ring segments for keratoconus. J Cataract Refract Surg. Apr 2004;30(4):812-20. doi:10.1016/j.jcrs.2003.12.005
• Siganos D, Ferrara P, Chatzinikolas K, Bessis N, Papastergiou G. Ferrara intrastromal corneal rings for the correction of keratoconus. J Cataract Refract Surg. Nov 2002;28(11):1947-51. doi:10.1016/s0886-3350(02)01495-5
• Pinero DP, Alio JL, El Kady B, et al. Refractive and aberrometric outcomes of intracorneal ring segments for keratoconus: mechanical versus femtosecond-assisted procedures. Ophthalmology. Sep 2009;116(9):1675-87. doi:10.1016/j.ophtha.2009.05.016
• Alio JL, Shabayek MH, Artola A. Intracorneal ring segments for keratoconus correction: long-term follow-up. J Cataract Refract Surg. Jun 2006;32(6):978-85. doi:10.1016/j.jcrs.2006.02.044
• Kubaloglu A, Sari ES, Cinar Y, et al. Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus: prospective randomized clinical trial. J Cataract Refract Surg. Sep 2010;36(9):1556-61. doi:10.1016/j.jcrs.2010.04.028
• Ertan A, Colin J. Intracorneal rings for keratoconus and keratectasia. J Cataract Refract Surg. Jul 2007;33(7):1303-14. doi:10.1016/j.jcrs.2007.02.048
• Colin J. European clinical evaluation: use of Intacs for the treatment of keratoconus. J Cataract Refract Surg. May 2006;32(5):747-55. doi:10.1016/j.jcrs.2006.01.064
• Patel S, Marshall J, Fitzke FW, 3rd. Model for deriving the optical performance of the myopic eye corrected with an intracorneal ring. J Refract Surg. Jul-Aug 1995;11(4):248-52. doi:10.3928/1081-597X-19950701-08
• Colin J, Malet FJ. Intacs for the correction of keratoconus: two-year follow-up. J Cataract Refract Surg. Jan 2007;33(1):69-74. doi:10.1016/j.jcrs.2006.08.057
• Kanellopoulos AJ, Pe LH, Perry HD, Donnenfeld ED. Modified intracorneal ring segment implantations (INTACS) for the management of moderate to advanced keratoconus: efficacy and complications. Cornea. Jan 2006;25(1):29-33. doi:10.1097/01.ico.0000167883.63266.60
• Swanson M. New technique for INTACS inserts implantation for the treatment of keratoconus and iatrogenic keratectasia. Investigative Ophthalmology & Visual Science. 2004;45(13):2897-2897
• Rabinowitz YS, Li X, Ignacio TS, Maguen E. INTACS inserts using the femtosecond laser compared to the mechanical spreader in the treatment of keratoconus. J Refract Surg. Oct 2006;22(8):764-71. doi:10.3928/1081-597X-20061001-06
• Ertan A, Bahadir M. Intrastromal ring segment insertion using a femtosecond laser to correct pellucid marginal corneal degeneration. J Cataract Refract Surg. Oct 2006;32(10):1710-6. doi:10.1016/j.jcrs.2006.06.015
• Coskunseven E, Kymionis GD, Tsiklis NS, et al. One-year results of intrastromal corneal ring segment implantation (KeraRing) using femtosecond laser in patients with keratoconus. Am J Ophthalmol. May 2008;145(5):775-9. doi:10.1016/j.ajo.2007.12.022
• Alfonso JF, Lisa C, Fernandez-Vega L, Madrid-Costa D, Montes-Mico R. Intrastromal corneal ring segment implantation in 219 keratoconic eyes at different stages. Graefes Arch Clin Exp Ophthalmol. Nov 2011;249(11):1705-12. doi:10.1007/s00417-011-1759-9
• Pinero DP, Alio JL, Teus MA, Barraquer RI, Michael R, Jimenez R. Modification and refinement of astigmatism in keratoconic eyes with intrastromal corneal ring segments. J Cataract Refract Surg. Sep 2010;36(9):1562-72. doi:10.1016/j.jcrs.2010.04.029
• Chan CC, Sharma M, Wachler BS. Effect of inferior-segment Intacs with and without C3-R on keratoconus. J Cataract Refract Surg. Jan 2007;33(1):75-80. doi:10.1016/j.jcrs.2006.09.012
• Ozerturk Y, Sari ES, Kubaloglu A, Koytak A, Pinero D, Akyol S. Comparison of deep anterior lamellar keratoplasty and intrastromal corneal ring segment implantation in advanced keratoconus. J Cataract Refract Surg. Feb 2012;38(2):324-32. doi:10.1016/j.jcrs.2011.08.033