New generation intraocular lens implantations in advanced-stage keratoconus cases

Yıl 2019, , 397 - 406, 31.12.2019

Cüneyt Karaarslan

https://doi.org/10.26559/mersinsbd.639076

Öz

Aim: The
aim of this study is to examine the applicability of intracorneal ring (ICR)
surgery, with or without collagen cross-linking (CXL) and subsequent indwelling
new generation foldable ıntraocular lens placement in patients with severe
keratoconus. Methods: A retrospective clinical observation study of a
7-year consecutive case series of 1,068 patients with keratoconus implanted
with Keraring® ICRs, with or without CXL and new generation foldable
intraocular lens implantation was completed. Follow-up examinations to assess
visual acuity, intraocular pressure, and signs of complications were performed
3 days and 3 weeks postoperatively, monthly thereafter for 3 months, at the end
of month 6 and 1 year. Results: ICRs were implanted alone in 607 eyes, with ICLs in 111 eyes, and with
PCIOLs in 198 eyes. Adjunct CXL was performed in 957 ICR-alone eyes, 119
ICR+ICL eyes, and ICR+PCIOL 144 eyes. All treatment plans reduced refraction
prescription strength, reduced corneal curvature, and improved patients’ visual
acuity substantially. Corneal topography showed marked flattening in all eyes.
Corneal irritation due to ICR extrusion led to ICR explantation from 18 eyes
(0.8%). Short-term elevation of intraocular pressure in 3 patients with ICL
implantation was resolved with 2% mannitol (100 ml during ICL placement plus
100 ml after surgery). Conclusion: Surgical
implantation of new generation foldable phakic or new generation foldable
multifocal pseudophakic intraocular lenses in patients with advanced
keratoconus may provide better visual acuity and rehabilitation in addition to
the combination of CXL and ICR. Therefore, these surgical procedures offer
better options for patients with advanced keratoconus than keratoplasty
procedures that are more invasive, expensive and having risks such as tissue
rejection.

Anahtar Kelimeler

: Collagen cross-linking, intracorneal ring, intraocular lens, keratoconus

İleri evre keratokonuslu olgularda yeni nesil intraoküler lens implantasyonları

Öz

Amaç: Bu çalışmada, ileri evre
keratokonuslu hastalarda, kollajen çapraz bağlama (CXL) uygulanan veya
uygulanmayan intra-korneal halka (ICR) cerrahili hastaların ve bunu takip eden
kalıcı lens yerleştirme işlemlerinin sonuçlarının karşılaştırılması amaçlandı. Yöntem: Kollajen çapraz bağlama
uygulanan veya uygulanmayan Keraring® ICR takılmış keratokonuslu, ve daha
sonradan daha iyi görme netliği için gereksinim gösteren uygun vakalara yeni
nesil IOL implantasyonu da yapılan 1068 hastayı 
kapsayan 7 yıllık ardışık bir vaka serisinin retrospektif klinik gözlem
çalışması tamamlandı. Görme keskinliği, göz içi basıncı ve komplikasyonları
değerlendirmek için takip muayeneleri, ameliyat sonrası, 3 gün, 3 hafta, 3 ay,
6 ay ve 1 yıl sonunda gerçekleştirildi. Bulgular:
Intrakorneal halka 607 göze yalnız, 111 göze yeni nesil ICL ve 198 göze yeni
nesil multifokal katlanır PCIOL ile implante edildi. Yardımcı CXL uygulaması,
957 ICR-gözde yalnız, 119 gözde ICR + yeni nesil ICL ile ve 144 gözde ICR +
yeni nesil multifocal katlanır PCIOL ile uygulandı. Tüm tedavi planları,
hastaların refraksiyon değerlerinde ve kornea eğriliğinde azalmaya neden oldu
ve görme keskinliğini büyük ölçüde iyileştirdi. Tüm gözlerde kornea
topografisindeki dikliklerde  belirgin
bir düzleşme izlendi. ICR ekstrüzyonuna bağlı kornea tahrişi 18 gözde (%0.8)
ICR eksplantasyonuna yol açtı. 3 hastada, ICL implantasyonu uygulaması
nedeniyle kısa süreli göz içi basıncı yükselmesi görüldü ve toplam 200 ml
%2’lik mannitol ile çözüldü (100 ml ICL implantasyonu sırasında ve post-op 100
ml ilave olarak). Sonuç: İleri evre
keratokonuslu hastalarda, CXL ve ICR kombinasyonuna ek olarak yeni nesil fakik
ya da  yeni nesil katlanır pseudofakik
göz içi lenslerin cerrahi implantasyonu, çok daha iyi bir görme keskinliği ve
rehabilitasyonu sağlayabilmektedir. Bu sebeple, bu cerrahi uygulamalar, uygun
ileri evre keratokonuslu hastalarda daha 
invazif, pahalı ve doku reddi riski gibi tehlikelere sahip olan
keratoplasti girişimlerine göre önceden davranıldığında çok daha iyi seçenekler
sunmaktadır.

Anahtar Kelimeler

Intrakorneal halka, intraoküler lens, keratokonus, kollajen çapraz bağlama

Kaynakça

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