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本文通过对圆锥角膜治疗方法的综述,为临床医生选择合适的治疗方法做出参考。通过数据库对“圆锥角膜”“隐形眼镜”“角膜胶原交联”“Intacs(角膜环)”“角膜成形术”“基因治疗”“不规则散光”等关键词进行搜索,并根据相关文献对圆锥角膜的治疗方法进行综述。眼镜和隐形眼镜可用于圆锥角膜早期,而疾病晚期时可采用前弹力层移植术、穿透性角膜成形术(PK)和深层前板层角膜成形术(DALK)、传导性角膜成形术和基因治疗。此外,角膜胶原交联可以阻止圆锥角膜进展,角膜基质环植入术(ICRS)通过使变形角膜变平,减少屈光不正以达到治疗目的。总得来说,眼科诊断技术和治疗方法的发展可以减缓圆锥角膜进展,从而减少晚期角膜圆锥患者对角膜移植的需要。选择恰当的圆锥角膜治疗方案可以帮助患者改善视力和预防失明。 相似文献
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圆锥角膜穿透性角膜移植术前后的角膜地形图分析吕岚王荣光邹留河董东生圆锥角膜是一种以局部角膜基质变薄、角膜进行性扩张为特征的角膜病,高度的不规则散光和基质瘢痕是导致视力下降的主要原因。早期的视力下降可通过戴镜矫正,随着病程的进展,由于高度的不规则散光视... 相似文献
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角膜基质环植入术(ICRS)是一种用于治疗轻中度圆锥角膜的手术方法。ICRS是通过植入基质环,使中央角膜扁平化,弧长缩短,角膜曲率半径增大,屈光力降低,从而改善角膜前突导致的轴性近视眼与不规则散光。ICRS具有微创性、安全性、有效性、可逆性且并发症少等优点,其中长期疗效较佳。本文中笔者就ICRS的发展史、适应症、手术方法、手术疗效的影响因素、术后处理及疗效的评估等方面进行阐述。 相似文献
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目的 观察穿透性角膜移植治疗准分子激光原位角膜磨削术(Laserin situkeratomileusis,LASIK)术后继发圆锥角膜的效果.方法 对6例LASIK术后确诊为继发圆锥角膜的患者进行穿透性角膜移植术,选用直径7~7.5mm植片,与植床等大.术后随访1~5年,观察和评价其疗效.结果 本研究6例患者LASIK术前角膜厚度平均为394.9μm.术后圆锥发生时间(13±3.4)个月,穿透性角膜移植术后,中央角膜厚度平均为504.7μm,视力明显增进,随访期内未见圆锥角膜复发.讨论我们建议,进行LASIK对术中切削时,角膜基质床的厚度不应小于270μm,角膜总厚度不应小于400μm.对LASIK术后继发圆锥角膜患者行穿透性角膜移植术,植床直径与角膜植片等大,术后再选择性拆除缝线,将有助于降低术后免疫排斥反应发生率和圆锥复发,减少手术源性散光,提高视力. 相似文献
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穿透性角膜移植术治疗中晚期圆锥角膜疗效分析 总被引:3,自引:2,他引:3
目的探讨穿透性角膜移植术治疗中晚期圆锥角膜的疗效。方法穿透性角膜移植术治疗27例30眼中晚期圆锥角膜患者,术后随访1~3a,比较术前术后视力变化,分析影响术后视力因素和手术并发症产生的原因。结果术后所有视力(裸眼)与术前相比均有提高,差异有明显统计学意义(P〈0.01)。30眼角膜植片均透明,其中1眼术后2周发生排斥反应,经治疗5d后恢复透明。植片的大小、术后并发症、拆线时间、术后角膜屈光状态,都会影响术后视力。结论穿透性角膜移植术治疗圆锥角膜中晚期患者可显著提高视力,且并发症少,是目前一种安全、有效的治疗方法。[眼科新进展2007:27(3).208-209,212] 相似文献
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Rohit Shetty Narayana Kannan M Kurian Mathew Anand D Prerna Mhaske Bhujang K Shetty 《Indian journal of ophthalmology》2009,57(2):115-119
Context
In contact lens-intolerant keratoconus patients, intrastromal placement of Intacs is becoming a promising new modality of treatment.Aims
To study the safety and efficacy of implantation of microthin corneal inserts (Intacs) in Asian-Indian keratoconus patients.Settings and Design
Retrospective interventional case series, in the cornea and refractive surgery service, at a tertiary care eye hospital in South India, between May 2006 and July 2007.Materials and Methods
Intacs (Addition Technology, USA) were successfully implanted by mechanically creating tunnels, in 12 eyes of 12 keratoconus patients, who were contact lens-intolerant. The patients (mean age 25.58 years, nine male and three female) had a minimum follow-up of six months. Five patients had severe keratoconus (mean K > 53 D) and nine had central cones.Results
All patients improved or retained visual acuity. The uncorrected visual acuity (UCVA) improved from a mean value of 0.06, (SD ± 0.08) to 0.19 postoperatively (SD± 0.15) (P= 0.01). The change in mean best corrected visual acuity (BCVA) was from 0.51, (SD ± 0.24), to 0.69, (SD ±0.00) (P = 0.01) postoperatively. The average central keratometry reading was 52.55 D. The change in mean K from 52.84 to 49.16 and 49.15 at one and six months respectively, was statistically significant. We did not have any major intra- or early postoperative complications. Eight of 12 eyes became contact lens-tolerant post-surgery.Conclusion
The procedure of Intacs implantation appears to be safe and effective in a small group of Indian population at an intermediate follow-up. 相似文献12.
Leonardo Torquetti Guilherme Ferrar Franklin Almei Leandro Cunh Paulo Ferrar Jesús Merayo-Lloves 《国际眼科杂志》2013,13(6):796-800
AIM:To evaluate the clinical outcomes after Ferrara intrastromal corneal ring segments (ICRS) reoperation in patients with keratoconus.RESULTS: The mean follow-up time after the reoperation was 30.5±9.7 months. The mean UCVA improved from 20/300 to 20/80 (P=0.005); the mean BCVA improved from 20/160 to 20/50 (P=0.0002), the mean keratometry reduced from 49.33±4.19D to 46.16±3.90D (P=0.0001), the mean pachymetry at the thinnest point increased from 450±42.9mm to 469±40.8mm (P=0.0001). The asphericity increased from -0.84±0.74 to -0.35±0.81 (P=0.15) and the spherical equivalent reduced from -4.64±4.87D to -3.04±3.45D (P=0.137). The changes in the asphericity and spherical equivalent were not statistically significant.CONCLUSION: Ferrara ICRS implantation showed to be a reversible and readjustable surgical procedure for keratoconus treatment. Good outcomes can be obtained even after removal, addition, reposition or exchange of ICRS. 相似文献
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Investigation of the efficiency of intrastromal ring segments with cross-linking using different sequence and timing for keratoconus 下载免费PDF全文
AIM:To evaluate and compare the efficacy and stability of intrastromal corneal ring segment (ICRs) implantation with cross-linking (CXL) using different sequence and timing.METHODS:In this single retrospective study, 86 keratoconic eyes subjected the ICRs implantation. We analyzed only 41 eyes that had complete follow-ups. They were divided into three groups:ICRs implantation was applied only (group normal), ICRs first followed by CXL immediately (group CXL-S), CXL first followed by ICRs long after (group CXL-B). The visual acuity, refractive results, keratometry were compared preoperatively and 1y postoperatively. Their differences among the three groups were also analyzed.RESULTS:Group normal comprised 25 eyes, group CXL-S 8 eyes, and group CXL-B 8 eyes. There were improvements in the mean uncorrected distance visual acuity (UDVA) and the mean corrected distance visual acuity (CDVA) compared preoperatively and 1y postoperatively {UDVA:0.31 (P=0.030) logarithmic minimum angle of resolution [logMAR] group normal, 0.4 (P=0.020) group CXL-S, 0.45 (P=0.001) group CXL-B; CDVA:0.21 logMAR (P=0.013) group normal, 0.30 (P=0.036) group CXL-S; 0.26 (P=0.000) group CXL-B}. The refractive and topographic outcomes also showed improvements. In terms of comparisons among the three groups, all the P values were above 0.05, showing no significant difference. But only group CXL-B had improvement in UDVA and CDVA for all the patients.CONCLUSION:With safety and good visual outcomes, ICRs implantation is a viable alternative for keratoconus. No significant difference was found among these three groups. 相似文献
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目的分析圆锥角膜(KC)手术前后角膜规则程度的变化,以及角膜缝线拆除对角膜规则程度的影响,对激光穿透性角膜移植手术(PK)在KC治疗中的作用进行评价。方法回顾分析了236例圆锥角膜使用激光环钻技术进行的穿透性角膜移植手术手术,使用角膜曲率计(Ophthalmometer,Type-H,190071Zeiss,Jena,Germany)对手术前后的角膜规则程度进行检测,并结合所测出的角膜曲率(K)值和角膜映光图像分成4组:(0)规则组,K〈50D;(1)轻度不规则组,K〈60;(2)中度不规则组,K≥60;(3)重度不规则组,K值不能读出,共4组。手术后第12、18个月依次拆除连续缝线,并同时随访记录各组别角膜规则程度,动态分析以上三个时间点角膜规则程度的变化特点。结果在三个时间点,规则组比例的递增趋势为4%-37%-61%轻度不规则组的变化趋势为12%-51%-33‰中度不规则组的递减趋势为38%-10%-4%;重度不规则组的变化趋势为46%-2%-2%。结论使用激光环钻和16针双线连续缝合的圆锥角膜手术病例中,穿透性角膜移植手术能有效改善病人的角膜表面规则程度,与缝线拆除相关的角膜规则程度呈动态变化,该变化主要发生在轻、中度组,缝线拆除本身并不会导致术后角膜规则程度下降。 相似文献
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穿透角膜移植术治疗急性圆锥角膜水肿的效果评价 总被引:1,自引:0,他引:1
目的评价穿透角膜移植术(PKP)治疗急性圆锥角膜的屈光增视效果.方法对急性圆锥角膜水肿共21例21眼,术时行双极电凝处理,与稳定期圆锥角膜18例22眼在同等条件下行PKP术.术后7天、1,3,6,12,15月分别以角膜地形图等方法测得角膜屈光状态与增视效果.结果急性圆锥角膜水肿术后7天裸眼视力0.42±0.16,最佳矫正视力0.61±0.22,术后15个月裸眼视力0.6±0.15(≥0.5者90.9%),矫正视力0.93±0.18(≥0.5者100%),模拟角膜计读数43.43D±2.53D,角膜非对称指数0.78±0.27,角膜散光2.25D±1.77D,等效球镜-1.76D±3.16D,每个时间点的屈光结果与稳定期圆锥角膜无统计学差异(P>0.05).结论急性圆锥角膜水肿与稳定期圆锥角膜行PKP术,同样可以获得迅速稳定的屈光增视效果. 相似文献
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Masoud Khorrami-Neja Rawshan Jumaah Farshid Karimi Khosrow Jadidi Mobina Farahani Reza Yousefi 《国际眼科杂志》2024,24(4):500-507
目的:比较MyoRing植入前后圆锥角膜(KCN)患者角膜前后表面散光和全屈光散光。
方法:历史队列研究。比较植入360度全环植入物(MyoRing)的KCN患者的术前和术后全屈光、角膜前后表面散光,术后3、6、9、12 mo连续随访四次。
结果:共纳入KCN患者79例85眼,其中男43例,女36例,平均年龄29±7.41(17-48)岁。随访期间,全屈光散光、角膜前后表面散光呈减少趋势。MyoRing植入后12 mo,总屈光散光测量值显著下降2.09 D(4.27±3.15 vs 2.18±1.63 D,P<0.001)。此外,术后测量显示,角膜前表面和后表面散光分别改善约3.20 D和0.59 D\〖6.40±1.90 vs 3.20±1.75 D(P<0.001)和1.30±0.55 vs 0.71±0.35(P<0.001)\〗
结论:MyoRing植入可显著改善散光参数,包括全屈光散光以及角膜前后表面散光。 相似文献
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Efekan Coskunseven George D. Kymionis Nikolaos S. Tsiklis Serife Atun Ebru Arslan Charalambos S. Siganos Mirco Jankov Ioannis G. Pallikaris 《Acta ophthalmologica. Supplement》2011,89(1):54-57
Acta Ophthalmol. 2011: 89: 54–57
Abstract.
Purpose: To report complications after the implantation of intrastromal corneal ring segments (Keraring; Mediphacos, Belo Horizonte, Brazil) in keratoconic eyes using a femtosecond laser (IntraLase; Advanced Medical Optics, Santa Ana, California, USA) for channel creation. Methods: Retrospective chart review of 531 patients (850 eyes) who underwent Keraring insertion using a femtosecond laser for channel creation. Intraoperative and postoperative complications were recorded. Results: Intraoperatively, there were 22 (2.7%) cases of incomplete channel formation. The rest of the intraoperative complications were galvo lag error (system malfunction) [five eyes (0.6%)], endothelial perforation [five eyes (0.6%)] and incorrect entry of the channel [two eyes (0.2%)]. Postoperatively, there were 11 (1.3%) cases of segment migration, two (0.2%) cases of corneal melting and one (0.1%) case of mild infection. The overall complication rate was 5.7% (49 cases out of 850 eyes). Conclusion: In this study, intracorneal ring segment implantation using a femtosecond laser for channel creation was related to a number of complications. The most common complications were incomplete channel creation (intraoperatively) and segment migration (postoperatively). 相似文献18.
Evaluation of anterior and posterior surfaces of the cornea using a dual Scheimpflug analyzer in keratoconus patients implanted with intrastromal corneal ring segments 下载免费PDF全文
Leonardo Torquetti Carlos Arce Jesús Merayo-Lloves Guilherme Ferrar Paulo Ferrar Brenno Signorelli Armando Signorelli 《国际眼科》2016,9(9):1283-1288
AIM: To evaluate corneal parameters measured with a dual Scheimpflug analyzer in keratoconus patients implanted with intrastromal corneal ring segments (ICRS).
METHODS: Fifty eyes of 40 keratoconus patients had Ferrara ICRS implantation from November 2010 to April 2014. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, keratometry, asphericity, elevation, pachymetry, root mean square (RMS), spherical aberration and coma were studied. All patients were evaluated using a dual Scheimpflug system.
RESULTS: The mean follow-up time after the procedure was 12.7mo. The mean UCVA improved from 0.82 to 0.31 (P<0.001); the mean BCVA improved from 0.42 to 0.05 (P<0.0001), the mean spherical refraction changed from -3.06±3.80 D to -0.80±2.5 D (P<0.0001) and the mean refraction astigmatism reduced from -4.51±2.08 D to -2.26±1.18 D (P<0.0001). The changes from preoperative to postoperative, in parameters of the anterior and posterior surface of the cornea, were statistically significant except the elevation posterior at the apex of the cornea and posterior asphericity.
CONCLUSION: The implantation of Ferrara ICRS induces changes in both anterior and posterior surfaces of the cornea. 相似文献
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Three-year clinical outcome after penetrating keratoplasty for keratoconus with the guided trephine system 总被引:1,自引:0,他引:1
Irene Ruhswurm MD Ursula Scholz MD Thomas Pfleger MD Martin Zehetmayer MD Georg Hanselmayer Christian Skorpik MD 《American journal of ophthalmology》1999,127(6):780-673
PURPOSE: To determine the long-term clinical outcome after keratoplasty with the guided trephine system in keratoconus eyes. METHODS: In a prospective study, all consecutive cases of penetrating keratoplasty had trephination performed with the guided trephine system, with which both donor and recipient cornea are trephined from the epithelial side with a same-sized blade. For wound closure, a double running antitorque suture technique with 10-0 nylon was used. Uncorrected and best-corrected Snellen visual acuity, subjective refraction, and astigmatism by keratometry were evaluated after final suture removal, 2 and 3 years postoperatively. RESULTS: In the 31 patients (31 eyes) enrolled, mean best-corrected visual acuity improved from 0.72 +/- 0.16 (20/30) after final suture removal to 0.88 +/- 0.15 (20/25) 3 years postoperatively (P < .001). The mean spherical equivalent increased from -0.86 +/- 2.10 diopters after final suture removal to -2.35 +/- 2.65 diopters 3 years postoperatively (P < .001). Mean keratometric astigmatism decreased from 4.68 +/- 1.76 diopters after final suture removal to 3.57 +/- 1.37 diopters 3 years postoperatively (P = .001). Furthermore, an increase in mean keratometric levels with time (P = .01) was observed and associated with myopic shift (r(s) = -.46, P = .008). CONCLUSION: With the guided trephine system, we attained favorable visual results, with prolonged improvement of visual acuity during the entire follow-up period. Our data show low and decreasing degrees of corneal astigmatism over time. During the follow-up period, a myopic shift was found after final suture removal. Nevertheless, this technique of performing same-sized grafts reduces postoperative residual myopia. 相似文献