Фотоабляция с рибофлавином как альтернатива применению Митомицина-С в эксимерной лазерной хирургии роговицы

Abstract

Purpose. To substantiate the advantages of photoablation with riboflavin as an alternative to the use of Mitomycin-C in excimer laser surgery of the cornea. Material and methods. The work is based on clinical observations of the results of 598 photorefractive and phototherapeutic operations. In all cases, keratoablation was performed after drip, aerosol, or combined saturation of the stroma with 0.1% or 0.25% isotonic riboflavin solution. Corneal OCT was performed on RTVue 100 and RTVue XR100 devices. Keratotopographic and densitometric studies were performed on a TMS-5 device. Results. With photokeratoablation of the stroma saturated with riboflavin, the response aseptic inflammatory and regenerative reactions, the severity and duration of the corneal syndrome decreased. In densitometry and OCT studies, an increase in optical density was noted with the formation of a membrane structure on the ablation surface and the effect of cross-linking in the stromal layers adjacent to the ablation zone. Shielding of induced secondary radiation by riboflavin and the formation of a Bowman-like membrane structure made it possible to avoid the development of an irreversible form of fibroplasia and a decrease in visual acuity. The formed membrane structure with cross-linking in the underlying stromal layers was a barrier between pro-inflammatory epithelial and stromal cytokines, which predetermine the development of fibroplasia during photokeratoablation. Conclusion. Photokeratoablation with riboflavin prevents the development of an irreversible form of fibroplasia and can be considered as an alternative to the use of Mitomycin-C in photorefractive and phototherapeutic operations on the cornea by radiation from an argon-fluorine excimer laser. Key words: Mitomycin-C, riboflavin, fibroplasia, excimer laser corneal surgery, laser-induced crosslinking.