Кросслинкинг роговицы излучением эксимерного лазера на аргон-фторе

Abstract

Purpose. To substantiate the expediency of using ablative and subablative energy densities of an argon-fluorine excimer laser for corneal crosslinking. Material and methods. In the period from 1 month to 6 years, the results of more than 500 photorefractive and phototherapeutic operations with saturation of the cornea with riboflavin and the effect of crosslinking were analyzed. To activate riboflavin, secondary radiation was used, induced by the use of ablative and subablative energy densities of an argon-fluorine excimer laser. For an objective assessment of the effect of excimer laser crosslinking, we used the techniques of computed keratotopography, aberrometry, optical coherence tomography, and densitometry. Results. Clinical observations have shown that in most cases of photorefractive surgery of the cornea for the prevention of keratoectasias, it is sufficient to carry out ablation after saturation of the corneal stroma with 0.25% isotonic riboflavin solution for 3-10 minutes, depending on the degree of ametropia and the volume of tissue removed. This provided photoprotective protection of deeper stromal structures from the negative effects of ablation-induced secondary radiation. At the same time, upon completion of ablation, secondary radiation initiated the effect of crosslinking in the adjacent layers, which did not violate the elastic properties of the cornea. In a number of cases, the cross-linking effect was enhanced by additional exposure to energy densities below the ablation threshold and the formation of a Bowman-like membrane structure on the ablation surface. For keratoconus and corneal pathology, without and in combination with keratoectasia, the technology of therapeutic cross-linking was used. This technology provided for the saturation of the stroma with 0.1% or 0.25% isotonic riboflavin solution and its activation by subablative radiation energy densities of an argon-fluorine excimer laser. During therapeutic crosslinking, according to OCT and densitometry, all the classic signs of traditional corneal crosslinking were revealed. Conclusion. The radiation of an argon-fluorine excimer laser with the use of ablative pulse energy densities can be recommended for prophylactic crosslinking in all cases of corneal thinning during photorefractive surgeries, while the use of energy densities below the ablation threshold allows for therapeutic crosslinking in keratoconus and corneal ectasias of various etiology. Key words: excimer laser crosslinking, cornea, keratoconus, photorefractive ablation, riboflavin.