A.V. TERESHCHENKO, I.G. TRIFANENKOVA, S.K. DEMYANCHENKO, N.A. GOLOVACH, E.N. VISHNYAKOVA, E.V. EROKHINA, M.A. TIMOFEEV

Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution, Svyatoslav Fyodorov Str., 5, Kaluga, Russian Federation, 248007

  Tereshchenko A.V. ― D. Med. Sc, Director, tel. (4842) 505-767, e-mail: nauka@mntk.kaluga.ru

Trifanenkova I.G. ― Cand. Med. Sc., Deputy Director for Research, tel. (4842) 505-767, e-mail: nauka@mntk.kaluga.ru

Demyanchenko S.K. ― Cand. Med. Sc., Head of the Department of Optical-Reconstructive and Refractive Surgery, tel. (4842) 505-767, e-mail: nauka@mntk.kaluga.ru

Golovach N.A. ― ophthalmologist, tel. (4842) 505-767, e-mail: nauka@mntk.kaluga.ru

Vishnyakova E.N. ― ophthalmologist, tel. (4842) 505-767, e-mail: nauka@mntk.kaluga.ru

Erokhina E.V. ― Head of the Diagnostic Department №2, tel. (4842) 505-767, e-mail: nauka@mntk.kaluga.ru

Timofeev M.A. ― ophthalmologist, tel. (4842) 505-767, e-mail: nauka@mntk.kaluga.ru

 The research objective is to evaluate the clinical effectiveness of femtosecond laser refractive autokeratoplasty using a personalized mathematical model and specialized software on Femto LDV Z8 device.

Material and methods. 2 patients with keratoconus 3 stage were operated. An average age was 39±5 years. In both cases, the femtosecond laser refractive autokeratoplasty was performed. The data of biometry, computer keratotopography and spectral optical coherence tomography of the eye anterior segment were used for mathematical modeling. The results obtained by mathematical modeling determined the choice of specific settings of the femtosecond laser program. In the first case, corneal resection per diameters of 7.8-8.2 mm was made, providing a total tissue «deficit» on the cornea anterior surface about 0.4 mm; in the second case ― per diameters of 7.8-8.1 mm, which created a total tissue «deficit» on the cornea anterior surface about 0.3 mm. The maximum follow-up was 2 months.

Results. The patients noted an improvement in vision from the first day after the surgery. During 2 months of follow-up, the increase both in best corrected visual acuity and visual acuity without correction were observed as compared with baseline values. The average keratometry was at 37±3. The anterior chamber depth was 3.1±0.2, indicators of astigmatism were 3,5 and 4,75 diopter with original values of 7 and 9 diopters. Patients are satisfied with the treatment.

Conclusion. The personalized mathematical calculation of corneal femtoresection parameters allows achieving the planned refractive effect of femtolaser refractive autokeratoplasty. Further research is needed to obtain objective data about the effectiveness and stability of the results of thekeratoconus surgical treatment technology.

Key words: keratoconus, femtolaser refractive autokeratoplasty, personalized mathematical model.

REFERENCES

1. Bikbov M.M., Bikbova G.M. Ehktazii rogovitsy (patogenez, patomorfologiya, klinika, diagnostika, lechenie) [Corneal ectasia (pathogenesis, pathomorphology, clinic, diagnosis, treatment)]. Moscow: Oftalʹmologiya, 2011. 168 p.
2. Gorskova E.N. Klinika, patogeneticheskie varianty techeniya, diagnostika i rolʹ medikamentoznykh sredstv v lechenii keratokonusa: avtoref. dis. … d-ra med. nauk [Clinic, pathogenetic variants of the course, diagnostics and role of medications in the treatment of keratoconus. Synopsis of dis. Dr med. sciences]. Moscow, 1998. 37 p.
3. Titarenko 3.D. Novye metody khirurgicheskogo i medikamentoznogo lecheniya keratokonusa: avtoref. dis. … d-ra med. nauk [New methods of surgical and medicamentous treatment of keratoconus. Synopsis of dis. Dr med. sciences]. Odessa, 1984. 34 p.
4. Rabinowitz Y.S. Keratoconus. Surv. Ophthalmol, 1998, no. 42, pp. 297-319.
5. Zolotorevskiy A.V., Zolotorevskiy K.A., Abdullaev Eh.Eh. The experience of treating patients with keratoconus and keratectasias. Klinicheskaya meditsina, 2013, vol. 5, no. 1, pp. 40-44 (in Russ.).
6. Kymionis G.D. Long-term follow-up of corneal collagen cross-linking for keratoconus ― the Cretan study. Cornea, 2014, vol. 33, no. 10, pp. 1071-1079.
7. Wollensak G., Spoerl E., Wilsch M., Seiler T. Keratocyte apoptosis after corneal collagen cross-linking using riboflavin/UVA treatment. Cornea, 2004, vol. 23, no. 1, pp. 43-9.
8. Markova E.Yu., Ovchinnikova A.V., Trufanov S.V. Femtolaser keratoplasty in a child with corneal opacity. Clinical case. Oftalʹmologiya, 2014, vol. 11, no. 1, pp. 79-82 (in Russ.).
9. Buzonetti L., Petrocelli G., Valente P. Big-bubble deep anterior lamellar keratoplasty assisted by femtosecond laser in children. Cornea, 2012, vol. 31, no. 9, pp. 1031-1036.
10. Joseph A., Fernandez S.T., Ittyerah T.P. et al. Keratoplasty in congenital corneal opacity. Ind. J. Ophthalmol, 1980, no. 28, pp. 79-80.
11. Sitnik G.V. Femtolaser refractive autokeratoplasty: a new way of treating keratoconus. Meditsinskiy zhurnal. BGMU, 2015, no. 4, pp. 113-117 (in Russ.).
12. Sitnik G.V., Slonimskiy A.Yu., Slonimskiy Yu.B. Femtolaser refractive autokeratoplasty: first results and prospects. Oftalʹmologiya, 2015, vol. 12, no. 3, pp. 22-28 (in Russ.).
13. Sitnik G.V., Slonimskiy A.Yu., Slonimskiy Yu.B., Imshenetskaya T.A. Femtolaser refractive autokeratoplasty — a new way of surgical treatment of keratoconus. Tochka zreniya. Vostok-Zapad, 2016, no. 1, pp. 42-45 (in Russ.).