PURPOSE To analyze the clinical outcomes obtained with asymmetric intracorneal corneal ring segments (ICRS) of variable thickness and width in patients with keratoconus, identifying predictive parameters of the final visual outcome. METHODS This prospective, longitudinal, non-comparative clinical trial enrolled 35 eyes of 27 patients with keratoconus with a significant difference among corneal topographic and comatic axes. All eyes underwent implantation of AJL-pro+ ICRS (AJL Ophthalmic). Visual, refractive, corneal topographic and aberrometric, and pachymetric changes were evaluated during a 3-month follow-up. RESULTS Significant changes were detected at 3 months after surgery in manifest sphere and cylinder, spherical equivalent, overall blur strength, and corrected distance visual acuity (CDVA) (P < .001). No losses of two or more lines of CDVA were observed, whereas 94.3% (33) of eyes gained one or more lines of CDVA. Keratometric readings and the magnitude of anterior corneal astigmatism were significantly reduced with surgery (P < .001), as well as the levels of corneal coma (P < .001) and spherical aberration (P = .007). Likewise, a significant change toward less prolateness was observed (P < .001). Significant correlations were found among the change in CDVA and preoperative CDVA (r = -0.532, P = .001), and between the change in primary coma root mean square and the preoperative level of spherical aberration (r = -0.542, P = .001) and coma root mean square (r = -0.719, P < .001). CONCLUSIONS The implantation of the ICRS evaluated in keratoconus with no coincidence between topographic and comatic axes regularizes the corneal shape and reduces the level of higher order aberrations, inducing a significant visual improvement. [J Refract Surg. 2021;37(10):693-699.].

中文翻译：

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飞秒激光辅助植入非对称 ICRS 在圆锥角膜中的临床结果，与地形轴和彗形轴不重合。

目的 分析圆锥角膜患者使用不同厚度和宽度的不对称角膜内角膜环段 (ICRS) 获得的临床结果，确定最终视觉结果的预测参数。方法 这项前瞻性、纵向、非比较性临床试验纳入了 27 名圆锥角膜患者的 35 只眼，角膜地形图和彗形轴之间存在显着差异。所有眼睛都接受了 AJL-pro+ ICRS (AJL Ophthalmic) 的植入。在 3 个月的随访期间评估了视觉、屈光、角膜地形和像差以及厚度变化。结果 术后 3 个月检测到显着球面和圆柱面、等效球面、整体模糊强度和矫正远视力 (CDVA) 的显着变化 (P < .001)。没有观察到两条或多条 CDVA 线的损失，而 94.3% (33) 的眼睛获得一条或多条 CDVA 线。角膜曲率读数和角膜前部散光的程度在手术后显着降低（P < .001），以及角膜彗差水平（P < .001）和球面像差（P = .007）。同样，观察到了显着变化，变得更短（P < .001）。CDVA的变化与术前CDVA的变化（r = -0.532，P = .001）以及原发性慧差均方根的变化与术前球差水平（r = -0.542，P = . 001) 和彗差均方根 (r = -0.719, P < .001)。结论 在圆锥角膜中植入 ICRS 后，地形轴和彗形轴之间没有重合，使角膜形状规则化并降低了高阶像差的水平，从而显着改善了视觉。[J 折射外科杂志。2021;37(10):693-699]。