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First Author: S.Izmaylova RUSSIA
Co Author(s): B. Malyugin D. Merzlov D. Pokrovskiy E. Branchevskaya
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To evaluate the effectiveness of comprehensive complex treatment in patients with progressive keratectasia of different types.
Fyodorov Eye Microsurgery Complex, Corneal Department, Russia, Moscow, Beskudnikovsky Boulevard 59A, 127486
Our study included 262 patients with I, II and III stage progressive keratoconus, PMD, post-traumatic and iatrogenic keratectasia. The choice and sequence of treatment methods was based on standard pre- and postoperative examination data: UCVA, BCVA, keratotopography maps, ??? and confocal microscopy. All patients were divided into 2 groups. The first group consisted of 202 patients who had intracorneal rings implanted as a first step. The second group consisted of 60 patients, who had standard crosslinking performed as a first step. In 3 months after ICRS implantation, 62 patients from the first group underwent standard crosslinking. Surgical correction of residual ametropia was performed in 62 patients from the first group and 27 patients from the second group. We used topography-guided PRK in 41 cases, phakic toric IOL implantation in 20 cases and phacoemulsification with toric IOL implantation in 28 cases.
Post-op results are described as stable throughout follow-up and average indices showed: UCVA 0,44ḟ0,14; BCVA 0,7ḟ0,25; spherical eguivalent -0,75ḟ0,5 D, cylindrical eguivalent 0,75ḟ0,8D; refractive power in the area of maximal ectasia 41,5ḟ2,23 D, central corneal thickness 440ḟ11mm. Confocal microscopy reavealed reduction of guantity and intensity of supraendothelial folds and pronounced fibroplastic reaction in the area of implanted ICRS. There were no major complicathions during or after surgery.
Comprehensive complex treatment is a save and effective method, that allows us to avoid keratoplasty, provided that patients selection criteria are thoroughly followed. All parameters showed improvement at 48 months follow-up.