Abstract：
OBJECTIVE: To evaluate the effectiveness of sequential custom phototherapeutic keratectomy (SCTK) for granular corneal dystrophy type 1 (GCD1).
METHODS: Thirty-seven eyes of 21 patients with GCD1 were treated with SCTK to remove superficial opacifications, regularize the corneal surface, and decrease optical aberrations. SCTK is a sequence of custom therapeutic excimer laser keratectomies with step-by-step intraoperative corneal topography monitoring of results. Six eyes of 5 patients previously treated with penetrating keratoplasty received SCTK for disease recurrence. Pre-operative and postoperative corrected distance visual acuity (CDVA), refractive values, mean pupillary keratometry, and pachymetry were retrospectively analyzed. The mean follow-up period was 41.3 months.
RESULTS: SCTK provided significant decimal CDVA improvement, from 0.33 ± 0.22 to 0.63 ± 0.24 (P < .0001) at the last available follow-up visit. One eye, initially treated with penetrating keratoplasty, showed visually significant disease 8 years after the first SCTK and was re-treated. Mean corneal pachymetry difference between preoperative and final follow-up values was 78.42 ± 62.26 µm. Mean corneal curvature and the spherical component did not show a statistically significant change or hyperopic shift. Astigmatism and higher order aberration reduction were statistically significant.
CONCLUSIONS: SCTK is a powerful tool for the treatment of anterior corneal pathologies hindering vision and quality of life, such as GCD1. SCTK is less invasive and fosters more rapid visual recovery than penetrating keratoplasty or deep anterior lamellar keratoplasty. Providing significant visual improvement, SCTK can be the preferred initial treatment in eyes with GCD1. [J Refract Surg. 2023;39(6):422-429.].
METHODS: Thirty-seven eyes of 21 patients with GCD1 were treated with SCTK to remove superficial opacifications, regularize the corneal surface, and decrease optical aberrations. SCTK is a sequence of custom therapeutic excimer laser keratectomies with step-by-step intraoperative corneal topography monitoring of results. Six eyes of 5 patients previously treated with penetrating keratoplasty received SCTK for disease recurrence. Pre-operative and postoperative corrected distance visual acuity (CDVA), refractive values, mean pupillary keratometry, and pachymetry were retrospectively analyzed. The mean follow-up period was 41.3 months.
RESULTS: SCTK provided significant decimal CDVA improvement, from 0.33 ± 0.22 to 0.63 ± 0.24 (P < .0001) at the last available follow-up visit. One eye, initially treated with penetrating keratoplasty, showed visually significant disease 8 years after the first SCTK and was re-treated. Mean corneal pachymetry difference between preoperative and final follow-up values was 78.42 ± 62.26 µm. Mean corneal curvature and the spherical component did not show a statistically significant change or hyperopic shift. Astigmatism and higher order aberration reduction were statistically significant.
CONCLUSIONS: SCTK is a powerful tool for the treatment of anterior corneal pathologies hindering vision and quality of life, such as GCD1. SCTK is less invasive and fosters more rapid visual recovery than penetrating keratoplasty or deep anterior lamellar keratoplasty. Providing significant visual improvement, SCTK can be the preferred initial treatment in eyes with GCD1. [J Refract Surg. 2023;39(6):422-429.].
摘要：
目的：评估序贯定制光疗角膜切削术（SCTK）治疗1型颗粒状角膜营养不良（GCD1）的有效性。
方法：对21例GCD1患者的37只眼进行SCTK治疗，以消除浅表混浊，调整角膜表面，并减少光学像差。SCTK是一系列定制治疗性准分子激光角膜切除术，可逐步进行术中角膜地形图监测结果。先前接受穿透性角膜移植术治疗的5例患者的六只眼睛因疾病复发而接受了SCTK。术前和术后矫正视力（CDVA），屈光值，平均瞳孔角化术,和测厚仪进行了回顾性分析。平均随访期为41.3个月。
结果：SCTK提供了显着的十进制CDVA改进，从0.33±0.22到0.63±0.24（P<0.0001）在最后一次可用的随访访问。一只眼睛，最初用穿透性角膜移植术治疗，在第一次SCTK后8年表现出视觉上明显的疾病，并进行了重新治疗。术前和最终随访值之间的平均角膜厚度差异为78.42±62.26µm。平均角膜曲率和球形分量未显示出统计学上的显着变化或远视偏移。散光和高阶像差降低有统计学意义。
结论：SCTK是治疗阻碍视力和生活质量的角膜前病变的有力工具，例如GCD1。与穿透性角膜移植术或深板层角膜移植术相比，SCTK的侵入性较小，并且可以促进更快的视觉恢复。提供显著的视觉改善，SCTK可以是GCD1眼中的优选初始治疗。[JRefractSurg.2023年；39（6）：422-429。].
方法：对21例GCD1患者的37只眼进行SCTK治疗，以消除浅表混浊，调整角膜表面，并减少光学像差。SCTK是一系列定制治疗性准分子激光角膜切除术，可逐步进行术中角膜地形图监测结果。先前接受穿透性角膜移植术治疗的5例患者的六只眼睛因疾病复发而接受了SCTK。术前和术后矫正视力（CDVA），屈光值，平均瞳孔角化术,和测厚仪进行了回顾性分析。平均随访期为41.3个月。
结果：SCTK提供了显着的十进制CDVA改进，从0.33±0.22到0.63±0.24（P<0.0001）在最后一次可用的随访访问。一只眼睛，最初用穿透性角膜移植术治疗，在第一次SCTK后8年表现出视觉上明显的疾病，并进行了重新治疗。术前和最终随访值之间的平均角膜厚度差异为78.42±62.26µm。平均角膜曲率和球形分量未显示出统计学上的显着变化或远视偏移。散光和高阶像差降低有统计学意义。
结论：SCTK是治疗阻碍视力和生活质量的角膜前病变的有力工具，例如GCD1。与穿透性角膜移植术或深板层角膜移植术相比，SCTK的侵入性较小，并且可以促进更快的视觉恢复。提供显著的视觉改善，SCTK可以是GCD1眼中的优选初始治疗。[JRefractSurg.2023年；39（6）：422-429。].
