Офтальмохирургия. 2022; : 20-25
Коррекция астигматизма после сквозной кератопластики методом имплантации интрастромальных роговичных сегментов с применением фемтосекундного лазера
https://doi.org/10.25276/0235-4160-2022-1-20-25Аннотация
Цель. Анализ клинико-функциональных результатов коррекции астигматизма после сквозной кератопластики методом имплантации интрастромальных роговичных сегментов (ИРС) с применением фемтосекундного лазера (ФСЛ).
Материал и методы. В клиническое исследование вошли 22 пациента (22 глаза), которым были имплантированы ИРС с применением ФСЛ с целью коррекции посткератопластического астигматизма. До операции некорригированная острота зрения (НКОЗ) в среднем составила 0,09±0,05, корригированная острота зрения (КОЗ) – 0,30±0,12, величина сферического компонента рефракции (СКР) – 1,16±3,98 дптр, цилиндрического компонента рефракции (ЦКР) – –10,25±4,80 дптр, среднее значение кератометрии (Кср) – 43,59±2,14 дптр, корнеальный гистерезис (КГ) – 7,92±1,22 мм рт.ст., фактор резистентности роговицы (ФРР) – 7,01±1,81 мм рт.ст.
Результаты. Интра- и послеоперационных осложнений отмечено не было. Через 12 месяцев после операции НКОЗ составила 0,50±0,16, КОЗ – 0,60±0,05; СКР – 1,05±2,11 дптр, ЦКР – –2,20±0,64 дптр, Kср – 38,56±1,75 дптр, КГ – 8,95±1,05 мм рт.ст., ФРР – 8,44±1,44 мм рт.ст.
Заключение. Метод имплантации интрастромальных роговичных сегментов в роговичный трансплантат с применением фемтосекундного лазера продемонстрировал высокую рефракционную эффективность и безопасность при коррекции посткератопластического астигматизма, а также повысил биомеханические свойства роговичного трансплантата.
Список литературы
1. Gu ZY, Ye MJ, Ji KK, Liao RF. Long-term follow-up of astigmatic keratotomy for corneal astigmatism after penetrating keratoplasty. Acta Ophthalmol. 2016;94(7): 7–77. doi: 10.1111/aos.13061
2. Asena L, Altınörs DD. Visual rehabilitation after penetrating keratoplasty. Exp Clin Transplant. 2016;14(3): 130–134.
3. Gutfreund S, Leon P, Busin M. Microkeratome-assisted anterior lamellar keratoplasty for the correction of high-degree postkeratoplasty astigmatism. Cornea. 2017;36(7): 880–883. doi: 10.1097/ICO.0000000000001232
4. Kim BK, Mun SJ, Lee DG, Chung YT. Bilateral small incision lenticule extraction (SMILE) after penetrating keratoplasty. J Refract Surg. 2016;32(9): 644–647. doi: 10.3928/1081597X-20160526-01
5. Lee HS, Kim MS. Factors related to the correction of astigmatism by LASIK after penetrating keratoplasty. J Refract Surg. 2010;26(12): 960–965. doi: 10.3928/1081597X-20100212-07
6. Lisa C, García-Fernández М, Madrid-Costa D, Torquetti L, Merayo-Lloves J, Alfonso J. Femtosecond laser-assisted intrastromal corneal ring segment implantation for high astigmatism correction after penetrating keratoplasty. Cataract Refract Surg. 2013;39(7): 1660–1667.
7. Rashad KM. Laser in situ keratomileusis for correction of high astigmatism aft er penetrating keratoplasty. J Refract Surg. 2000;16(6): 701–710.
8. Prazeres TM, Souza AC, Pereira NC, Ursulino F, Grupenmacher L, de Souza LB. Intrastromal corneal ring segment implantation by femtosecond laser for the correction of residual astigmatism after penetrating keratoplasty. Cornea. 2011;30(12): 1293–1297. doi: 10.1097/ICO.0b013e31821821e1
9. Малюгин Б.Э., Токмакова А.Н., Каримова А.Н. Отдаленные результаты лазерной коррекции астигматизма после сквозной кератопластики у пациентов с кератоконусом. Практическая медицина. 2017;9: 128–132.
10. Hashemi H, Aghamirsalim M, Asgari S. Stromal rejection after SMILE for th e correction of astigmatism after graft. J Refract Surg. 2019;35(11): 737–739. doi: 10.3928/1081597X-20191010-01
11. Elkadim M, Myerscough J, Bovone C, Busin M. Astigmatism orientation after deep anterior lamellar keratoplasty for keratoconus and its correlation with preoperative peripheral corneal astigmatism. Cornea. 2020;39(2): 192–195. doi: 10.1097/ICO.0000000000002175
12. Sinitsyn MV, Pozdeyeva NA, Pashtayev NP. Comparative analysis of the intrastromal MyoRing implantation performed with the femtosecond laser. International Journal of Keratoconus and Ectatic Corneal Diseases. 2017;6(2): 1–9. 13. Pozdeyeva NA, Sinitsyn MV. Femtosecond laser-assisted intrastromal MyoRing implantation for correction of irregular astigmatism after penetrating keratoplasty and high myopia. Indian J Ophthalmol. Case Rep. 2021;1(1): 88–90.
13. Мороз ЗИ, Токмакова АН, Волкова ОС. Интрастромальная кератопластика с имплантацией роговичных сегментов в коррекции астигматизма после сквозной кератопластики по поводу кератоконуса. Офтальмохирургия. 2015;4: 70–77.
Fyodorov Journal of Ophthalmic Surgery. 2022; : 20-25
Astigmatism correction after penetrating keratoplasty by intrastromal corneal segments implantation using a femtosecond laser
https://doi.org/10.25276/0235-4160-2022-1-20-25Abstract
Purpose. Analysis of clinical and functional results of astigmatism correction after penetrating keratoplasty by intrastromal segment implantation (ICS) using a femtosecond laser (FSL).
Material and methods. The clinical study included 22 patients (22 eyes) who were implanted ICS using FSL in order to correct postkeratoplastic astigmatism. Before surgery, uncorrected visual acuity (UCVA) averaged 0.09±0.05, best corrected visual acuity (BCVA) – 0.3±0.22, the value of the spherical component of refraction (SCR) – 1.16±3.98 D, cylindrical component of refraction (CCR) – –10.25±4.80 D, mean keratometry value (Kave) – 43.59±3.99 D, corneal hysteresis (CH) – 7.94±1.44 mm Hg, corneal resistance factor (CRF) – 7.01±1.81 mm Hg.
Results. Intra- and postoperative complications were not observed. 12 months after the operation, the UCVA was 0.50±0.16, the BCVA – 0.60±0.18; SCR –1.05±3.18 D, CCR – –2.22±0.82D, Kave – 38.56±1.96 D, CH – 8.93±1.13 mm Hg, CRF – 8.44±1.44 mm Hg.
Conclusion. The method of the intrastromal corneal segments implantation into a corneal graft using a femtosecond laser has demonstrated high refractive efficiency and safety in correcting postkeratoplastic astigmatism and increased the biomechanical properties of the corneal graft.
References
1. Gu ZY, Ye MJ, Ji KK, Liao RF. Long-term follow-up of astigmatic keratotomy for corneal astigmatism after penetrating keratoplasty. Acta Ophthalmol. 2016;94(7): 7–77. doi: 10.1111/aos.13061
2. Asena L, Altınörs DD. Visual rehabilitation after penetrating keratoplasty. Exp Clin Transplant. 2016;14(3): 130–134.
3. Gutfreund S, Leon P, Busin M. Microkeratome-assisted anterior lamellar keratoplasty for the correction of high-degree postkeratoplasty astigmatism. Cornea. 2017;36(7): 880–883. doi: 10.1097/ICO.0000000000001232
4. Kim BK, Mun SJ, Lee DG, Chung YT. Bilateral small incision lenticule extraction (SMILE) after penetrating keratoplasty. J Refract Surg. 2016;32(9): 644–647. doi: 10.3928/1081597X-20160526-01
5. Lee HS, Kim MS. Factors related to the correction of astigmatism by LASIK after penetrating keratoplasty. J Refract Surg. 2010;26(12): 960–965. doi: 10.3928/1081597X-20100212-07
6. Lisa C, García-Fernández M, Madrid-Costa D, Torquetti L, Merayo-Lloves J, Alfonso J. Femtosecond laser-assisted intrastromal corneal ring segment implantation for high astigmatism correction after penetrating keratoplasty. Cataract Refract Surg. 2013;39(7): 1660–1667.
7. Rashad KM. Laser in situ keratomileusis for correction of high astigmatism aft er penetrating keratoplasty. J Refract Surg. 2000;16(6): 701–710.
8. Prazeres TM, Souza AC, Pereira NC, Ursulino F, Grupenmacher L, de Souza LB. Intrastromal corneal ring segment implantation by femtosecond laser for the correction of residual astigmatism after penetrating keratoplasty. Cornea. 2011;30(12): 1293–1297. doi: 10.1097/ICO.0b013e31821821e1
9. Malyugin B.E., Tokmakova A.N., Karimova A.N. Otdalennye rezul'taty lazernoi korrektsii astigmatizma posle skvoznoi keratoplastiki u patsientov s keratokonusom. Prakticheskaya meditsina. 2017;9: 128–132.
10. Hashemi H, Aghamirsalim M, Asgari S. Stromal rejection after SMILE for th e correction of astigmatism after graft. J Refract Surg. 2019;35(11): 737–739. doi: 10.3928/1081597X-20191010-01
11. Elkadim M, Myerscough J, Bovone C, Busin M. Astigmatism orientation after deep anterior lamellar keratoplasty for keratoconus and its correlation with preoperative peripheral corneal astigmatism. Cornea. 2020;39(2): 192–195. doi: 10.1097/ICO.0000000000002175
12. Sinitsyn MV, Pozdeyeva NA, Pashtayev NP. Comparative analysis of the intrastromal MyoRing implantation performed with the femtosecond laser. International Journal of Keratoconus and Ectatic Corneal Diseases. 2017;6(2): 1–9. 13. Pozdeyeva NA, Sinitsyn MV. Femtosecond laser-assisted intrastromal MyoRing implantation for correction of irregular astigmatism after penetrating keratoplasty and high myopia. Indian J Ophthalmol. Case Rep. 2021;1(1): 88–90.
13. Moroz ZI, Tokmakova AN, Volkova OS. Intrastromal'naya keratoplastika s implantatsiei rogovichnykh segmentov v korrektsii astigmatizma posle skvoznoi keratoplastiki po povodu keratokonusa. Oftal'mokhirurgiya. 2015;4: 70–77.
