Soosan Jacob, Amar Agarwal, Shady T Awwad, Hyeck Soo Son, Gerd U Auffarth, Riya Abraham, Smita Narasimhan
{"title":"移植角膜异体基质内环段（cair）术后调整以改善视觉和地形结果。","authors":"Soosan Jacob, Amar Agarwal, Shady T Awwad, Hyeck Soo Son, Gerd U Auffarth, Riya Abraham, Smita Narasimhan","doi":"10.3928/1081597X-20250515-05","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To report adjustment of different corneal allogeneic intrastromal ring segments (CAIRS) parameters in a group of patients with suboptimal visual and topographic results.</p><p><strong>Methods: </strong>Thirteen eyes of 13 patients with suboptimal first-stage outcomes in the form of a decrease or lack of improvement in uncorrected (UDVA) or corrected (CDVA) distance visual acuity or complaining of decreased visual quality together with worsening of topographic map were included in this retrospective interventional case series. Adjustment was performed for arc length, width, thickness, placement, or optical zone.</p><p><strong>Results: </strong>Post-implantation (Intervention-1) mean improvement in UDVA and CDVA compared to preoperatively was 1.5 ± 3 (range: 6 to 3) and 0.2 ± 1.5 (range: 2.5 to 3) lines of vision, respectively. Three lines of UDVA and 0.5 to 3 lines of CDVA were lost in 2 and 5 patients, respectively. Post-adjustment (Intervention-2) mean improvement in UDVA and CDVA compared to preoperatively was 3.6 ± 3 (range: 10 to 0) and 1.15 ± 1.6 (range: 5.5 to 0) lines, respectively. No patient lost any lines of UDVA or CDVA after adjustment. All patients who lost lines after Intervention-1 regained it after adjustment. The Friedman chi-squared test showed a global difference across the three time points for UDVA, CDVA, spherical equivalent (SE), refractive astigmatism (RA), keratometry (steep [Ksteep], flat [Kflat], and mean [Kmean]) (chi-square = 11.7 to 16.8, <i>P</i> ≤ .003). Bonferroni-corrected Wilcoxon tests showed significant improvements for UDVA, SE, RA, Ksteep, Kflat, Kmean, and maximum keratometry (Kmax) between different time points. Before Intervention-1 to after Intervention-2 contrast yielded smaller <i>P</i> values than before Intervention-1 to after Intervention-1 for all parameters, thus showing larger improvements. Kmax showed a statistically significant difference but was not considered important because Kmax after CAIRS implantation is often outside the visual axis.</p><p><strong>Conclusions: </strong>Adjustments are possible to try and improve-suboptimal results after CAIRS implantation.</p>","PeriodicalId":16951,"journal":{"name":"Journal of refractive surgery","volume":"41 8","pages":"e814-e821"},"PeriodicalIF":3.0000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Postoperative Adjustment of Implanted Corneal Allogeneic Intrastromal Ring Segments (CAIRS) to Improve Visual and Topographic Outcomes.\",\"authors\":\"Soosan Jacob, Amar Agarwal, Shady T Awwad, Hyeck Soo Son, Gerd U Auffarth, Riya Abraham, Smita Narasimhan\",\"doi\":\"10.3928/1081597X-20250515-05\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To report adjustment of different corneal allogeneic intrastromal ring segments (CAIRS) parameters in a group of patients with suboptimal visual and topographic results.</p><p><strong>Methods: </strong>Thirteen eyes of 13 patients with suboptimal first-stage outcomes in the form of a decrease or lack of improvement in uncorrected (UDVA) or corrected (CDVA) distance visual acuity or complaining of decreased visual quality together with worsening of topographic map were included in this retrospective interventional case series. Adjustment was performed for arc length, width, thickness, placement, or optical zone.</p><p><strong>Results: </strong>Post-implantation (Intervention-1) mean improvement in UDVA and CDVA compared to preoperatively was 1.5 ± 3 (range: 6 to 3) and 0.2 ± 1.5 (range: 2.5 to 3) lines of vision, respectively. Three lines of UDVA and 0.5 to 3 lines of CDVA were lost in 2 and 5 patients, respectively. Post-adjustment (Intervention-2) mean improvement in UDVA and CDVA compared to preoperatively was 3.6 ± 3 (range: 10 to 0) and 1.15 ± 1.6 (range: 5.5 to 0) lines, respectively. No patient lost any lines of UDVA or CDVA after adjustment. All patients who lost lines after Intervention-1 regained it after adjustment. The Friedman chi-squared test showed a global difference across the three time points for UDVA, CDVA, spherical equivalent (SE), refractive astigmatism (RA), keratometry (steep [Ksteep], flat [Kflat], and mean [Kmean]) (chi-square = 11.7 to 16.8, <i>P</i> ≤ .003). Bonferroni-corrected Wilcoxon tests showed significant improvements for UDVA, SE, RA, Ksteep, Kflat, Kmean, and maximum keratometry (Kmax) between different time points. Before Intervention-1 to after Intervention-2 contrast yielded smaller <i>P</i> values than before Intervention-1 to after Intervention-1 for all parameters, thus showing larger improvements. Kmax showed a statistically significant difference but was not considered important because Kmax after CAIRS implantation is often outside the visual axis.</p><p><strong>Conclusions: </strong>Adjustments are possible to try and improve-suboptimal results after CAIRS implantation.</p>\",\"PeriodicalId\":16951,\"journal\":{\"name\":\"Journal of refractive surgery\",\"volume\":\"41 8\",\"pages\":\"e814-e821\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of refractive surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3928/1081597X-20250515-05\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of refractive surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3928/1081597X-20250515-05","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Postoperative Adjustment of Implanted Corneal Allogeneic Intrastromal Ring Segments (CAIRS) to Improve Visual and Topographic Outcomes.
Purpose: To report adjustment of different corneal allogeneic intrastromal ring segments (CAIRS) parameters in a group of patients with suboptimal visual and topographic results.
Methods: Thirteen eyes of 13 patients with suboptimal first-stage outcomes in the form of a decrease or lack of improvement in uncorrected (UDVA) or corrected (CDVA) distance visual acuity or complaining of decreased visual quality together with worsening of topographic map were included in this retrospective interventional case series. Adjustment was performed for arc length, width, thickness, placement, or optical zone.
Results: Post-implantation (Intervention-1) mean improvement in UDVA and CDVA compared to preoperatively was 1.5 ± 3 (range: 6 to 3) and 0.2 ± 1.5 (range: 2.5 to 3) lines of vision, respectively. Three lines of UDVA and 0.5 to 3 lines of CDVA were lost in 2 and 5 patients, respectively. Post-adjustment (Intervention-2) mean improvement in UDVA and CDVA compared to preoperatively was 3.6 ± 3 (range: 10 to 0) and 1.15 ± 1.6 (range: 5.5 to 0) lines, respectively. No patient lost any lines of UDVA or CDVA after adjustment. All patients who lost lines after Intervention-1 regained it after adjustment. The Friedman chi-squared test showed a global difference across the three time points for UDVA, CDVA, spherical equivalent (SE), refractive astigmatism (RA), keratometry (steep [Ksteep], flat [Kflat], and mean [Kmean]) (chi-square = 11.7 to 16.8, P ≤ .003). Bonferroni-corrected Wilcoxon tests showed significant improvements for UDVA, SE, RA, Ksteep, Kflat, Kmean, and maximum keratometry (Kmax) between different time points. Before Intervention-1 to after Intervention-2 contrast yielded smaller P values than before Intervention-1 to after Intervention-1 for all parameters, thus showing larger improvements. Kmax showed a statistically significant difference but was not considered important because Kmax after CAIRS implantation is often outside the visual axis.
Conclusions: Adjustments are possible to try and improve-suboptimal results after CAIRS implantation.
期刊介绍：
The Journal of Refractive Surgery, the official journal of the International Society of Refractive Surgery, a partner of the American Academy of Ophthalmology, has been a monthly peer-reviewed forum for original research, review, and evaluation of refractive and lens-based surgical procedures for more than 30 years. Practical, clinically valuable articles provide readers with the most up-to-date information regarding advances in the field of refractive surgery. Begin to explore the Journal and all of its great benefits such as:
• Columns including “Translational Science,” “Surgical Techniques,” and “Biomechanics”
• Supplemental videos and materials available for many articles
• Access to current articles, as well as several years of archived content
• Articles posted online just 2 months after acceptance.
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