Десятилетний опыт применения оригинального алгоритма хирургического лечения пациентов с начальными стадиями кератоконуса

Abstract

Purpose. Analyze of the long-term results of treatment of patients with progressive keratoconus initial stages performed according to the developed algorithm. Material and methods. Clinical studies were carried out on the basis of a retrospective analysis of three comparison groups, depending on the tactics of surgery. Group 1 consisted of 843 patients (1186 eyes) with progression of keratoconus who underwent crosslinking. Group 2 consisted of 1185 patients (1343 eyes) who underwent intrastromal keratoplasty with implantation of corneal segments (ISKP with implantation of RS) with a mechanical (1007 eyes) or femtolaser (336 eyes) method. Group 3 consisted of 912 patients (1270 eyes), these patients underwent combined treatment – ISKP+UV crosslinking. The observation was carried out for 10 years. Results. As a result of the observation of patients for 10 years from the moment of UV crosslinking, an increase in UCVA and BCVA was revealed 10 years after surgery by 0.33±0.05 and 0.2±0.04, respectively. There was a significant increase in the central thickness of the cornea, on average by 12.75±0.08µm after 10 years. When analyzing the results of the observation of group 2, an increase in UCVA and BCVA was observed by 3–6 months after MS implantation. Keratometry indices (Kmax) decreased by an average of 3.5±1.3 diopters after 10 years. There was an increase in the central corneal thickness by 19.25±2.2µm after 10 years. As a result of the observation of patients for 15 months after the combined treatment (UV-crosslinking+ISCP), an increase in UCVA and BCVA was revealed by 0.17±0.10 and 0.25±15, respectively. Keratometry indices (Kmax) decreased by an average of 4.1±0.9 diopters after 15 months. There was an increase in the central corneal thickness by an average of 15±6.2µm after 15 months. Conclusion. Our research has shown that after 6 years there is no need to repeat UV crosslinking. With the correct location of the corneal segments, the progression of ectasia stops, and the UCVA and BCVA increase. Differences were revealed in the dynamics of the postoperative course in patients with combined UV crosslinking and implantation of corneal segments, which is obviously associated with their mutual effect on the ectasized cornea. In order to improve the quality of life of patients with the initial stages of keratoconus, these methods of treating keratectasias can be used in wide clinical practice without the threat of a decrease in clinical and functional results over a long period of time. Key words: keratoconus, classification, algorithm, crosslinking, corneal segment