İleri evre keratokonuslu olgularda yeni nesil intraoküler lens implantasyonları

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

New generation intraocular lens implantations in advanced-stage keratoconus cases

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.

Keywords:

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

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