PURPOSE To evaluate vision and corneal surface regularity after each step of a three-step surgical treatment of keratoconus and post-laser in situ keratomileusis (LASIK) ectasia (implantation of intracorneal ring segments [ICRS], corneal cross-linking [CXL], and implantation of toric intraocular contact lenses [ICLs]). METHODS Thirty-one eyes of 24 patients with moderate to severe keratoconus and post-LASIK ectasia (stages II and III of Amsler-Krumeich classification) were included. All eyes underwent all three steps. The time interval between ICRS implantation and CXL was 4 to 6 weeks, and ICL implantation was performed 6 to 8 months after CXL. Visual acuity, refraction, and corneal topometric indices were evaluated with the Pentacam system (index of surface variance [ISV], index of vertical asymmetry [IVA], keratoconus index [KI], central keratoconus index [CKI], index of height asymmetry [IHA], index of height decentration [IHD], and corneal wavefront parameters [eg, higher order aberrations, spherical aberration, and coma]). RESULTS Decimal uncorrected distance visual acuity (UDVA) improved from 0.13 ± 0.17 preoperatively to 0.69 ± 0.18 at 1 year, whereas corrected distance visual acuity (CDVA) improved from 0.56 ± 0.24 to 0.80 ± 0.18, respectively. The topometric indices ISV, IVA, KI, and IHD also improved significantly, whereas CKI and IHA showed no significant improvement. Higher order aberrations, spherical aberration, and coma improved significantly compared to baseline. CONCLUSIONS The combined use of ICRS, CXL, and ICL implantation significantly improves visual acuity, higher order aberrations, and corneal shape in moderate and severe keratoconus and post-LASIK ectasia. [J Refract Surg. 2020;36(2):104-109.].

中文翻译：

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圆锥角膜和LASIK术后蜕膜炎的三步治疗：植入ICRS，角膜交联和复曲面复眼后房角人工晶状体植入。

目的评估圆锥角膜和激光后原位角膜磨镶术（LASIK）扩张三步手术（植入角膜内环段[ICRS]，角膜交联[CXL]和植入复曲面眼内接触镜[ICL]。方法包括24例中度至重度圆锥角膜和LASIK术后扩张（Amsler-Krumeich分类的II和III期）患者的31只眼。所有的眼睛都经历了所有三个步骤。ICRS植入与CXL之间的时间间隔为4至6周，而CCL植入后6至8个月进行ICL植入。使用Pentacam系统评估视力，屈光度和角膜地形指数（表面变异指数[ISV]，垂直不对称指数[IVA]，圆锥角膜指数[KI]，圆锥角膜中央指数[CKI]，高度不对称指数[IHA]，高度偏心指数[IHD]和角膜波阵面参数（例如，高阶像差，球面像差和彗差））。结果术前十进制未矫正远视力（UDVA）从术前的0.13±0.17提高到0.69±0.18，而矫正远视力（CDVA）分别从0.56±0.24提高到0.80±0.18。拓扑指数ISV，IVA，KI和IHD也显着改善，而CKI和IHA没有显着改善。与基线相比，高阶像差，球面像差和彗差显着改善。结论结合使用ICRS，CXL和ICL植入可显着改善视敏度，更高阶像差，中度和重度圆锥角膜和LASIK术后扩张期的角膜形状。[J Refract Surg。2020; 36（2）：104-109。]。