Abstract：
OBJECTIVE: The aim of this study was to describe the safety and efficacy of the Tel-Aviv Protocol (epithelial photorefractive keratectomy and corneal cross-linking) as a treatment for postrefractive surgery corneal ectasia.
METHODS: This study includes 8 eyes from 7 patients, each diagnosed with postrefractive surgery ectasia years after refractive surgery and treated with the Tel-Aviv Protocol. The procedure included transepithelial PRK using the EX500 excimer laser, a 50-μm laser ablation of the epithelium and anterior stroma, delivered on the visual axis with cyclotorsion correction, treating up to 50% of refractive astigmatism. After the epithelial photorefractive keratectomy, all patients underwent corneal cross-linking.
RESULTS: The mean keratometry (K) and maximal K both decreased [from 43.37 ± 2.23 to 41.84 ± 2.01 ( P = 0.03) and from 44.95 ± 3.08 to 42.78 ± 2.19 ( P = 0.03), respectively]. Astigmatism was significantly reduced (from 3.53 ± 2.36 to 0.88 ± 0.89 diopter; P = 0.02). Uncorrected visual acuity improved significantly in all patients from a mean of 0.56 ± 0.32 to 0.15 ± 0.14 logMAR ( P = 0.01). Best-corrected visual acuity improved from 0.22 ± 0.24 to 0.06 ± 0.06 logMAR ( P = 0.07; 1-tail P = 0.04). All patients maintained visual acuity during the follow-up period, up to 25 months, mean = 329 days. The Tel-Aviv Protocol was found to be safe [mean safety index: 1.63 ± 1.03 (range: 1.00-4)] and effective [mean efficacy index: 1.29 ± 0.66 (range: 0.71-2.1)].
CONCLUSIONS: The Tel-Aviv Protocol, developed initially for keratoconus treatment, is a safe and promising procedure to stop postrefractive surgery ectasia progression while significantly improving vision, thereby avoiding keratoplasty.
METHODS: This study includes 8 eyes from 7 patients, each diagnosed with postrefractive surgery ectasia years after refractive surgery and treated with the Tel-Aviv Protocol. The procedure included transepithelial PRK using the EX500 excimer laser, a 50-μm laser ablation of the epithelium and anterior stroma, delivered on the visual axis with cyclotorsion correction, treating up to 50% of refractive astigmatism. After the epithelial photorefractive keratectomy, all patients underwent corneal cross-linking.
RESULTS: The mean keratometry (K) and maximal K both decreased [from 43.37 ± 2.23 to 41.84 ± 2.01 ( P = 0.03) and from 44.95 ± 3.08 to 42.78 ± 2.19 ( P = 0.03), respectively]. Astigmatism was significantly reduced (from 3.53 ± 2.36 to 0.88 ± 0.89 diopter; P = 0.02). Uncorrected visual acuity improved significantly in all patients from a mean of 0.56 ± 0.32 to 0.15 ± 0.14 logMAR ( P = 0.01). Best-corrected visual acuity improved from 0.22 ± 0.24 to 0.06 ± 0.06 logMAR ( P = 0.07; 1-tail P = 0.04). All patients maintained visual acuity during the follow-up period, up to 25 months, mean = 329 days. The Tel-Aviv Protocol was found to be safe [mean safety index: 1.63 ± 1.03 (range: 1.00-4)] and effective [mean efficacy index: 1.29 ± 0.66 (range: 0.71-2.1)].
CONCLUSIONS: The Tel-Aviv Protocol, developed initially for keratoconus treatment, is a safe and promising procedure to stop postrefractive surgery ectasia progression while significantly improving vision, thereby avoiding keratoplasty.
摘要：
目的：本研究的目的是描述特拉维夫方案（上皮性屈光性角膜切削术和角膜交联术）作为手术后角膜扩张症治疗的安全性和有效性。
方法：本研究包括7名患者的8只眼，每个患者在屈光手术后数年被诊断为手术后扩张症，并接受特拉维夫方案治疗。该程序包括使用EX500准分子激光的跨上皮PRK，上皮和前基质的50μm激光消融，在视觉轴上进行旋转校正，治疗高达50％的屈光散光。上皮性屈光性角膜切除术后，所有患者均接受角膜交联.
结果：平均角膜曲率（K）和最大K均下降[从43.37±2.23降至41.84±2.01（P=0.03），从44.95±3.08降至42.78±2.19（P=0.03），分别]。散光显着降低（从3.53±2.36降至0.88±0.89屈光度；P=0.02）。所有患者的未矫正视力均从平均0.56±0.32到0.15±0.14logMAR显着提高（P=0.01）。最佳矫正视力从0.22±0.24提高到0.06±0.06logMAR（P=0.07；1尾P=0.04）。所有患者在随访期间均保持视力,长达25个月,平均值=329天。特拉维夫方案被发现是安全的[平均安全指数：1.63±1.03（范围：1.00-4）]和有效的[平均疗效指数：1.29±0.66（范围：0.71-2.1）]。
结论：特拉维夫议定书，最初开发用于圆锥角膜治疗，是一种安全且有希望的方法，可以阻止手术后扩张进展，同时显着改善视力，从而避免角膜移植术。
方法：本研究包括7名患者的8只眼，每个患者在屈光手术后数年被诊断为手术后扩张症，并接受特拉维夫方案治疗。该程序包括使用EX500准分子激光的跨上皮PRK，上皮和前基质的50μm激光消融，在视觉轴上进行旋转校正，治疗高达50％的屈光散光。上皮性屈光性角膜切除术后，所有患者均接受角膜交联.
结果：平均角膜曲率（K）和最大K均下降[从43.37±2.23降至41.84±2.01（P=0.03），从44.95±3.08降至42.78±2.19（P=0.03），分别]。散光显着降低（从3.53±2.36降至0.88±0.89屈光度；P=0.02）。所有患者的未矫正视力均从平均0.56±0.32到0.15±0.14logMAR显着提高（P=0.01）。最佳矫正视力从0.22±0.24提高到0.06±0.06logMAR（P=0.07；1尾P=0.04）。所有患者在随访期间均保持视力,长达25个月,平均值=329天。特拉维夫方案被发现是安全的[平均安全指数：1.63±1.03（范围：1.00-4）]和有效的[平均疗效指数：1.29±0.66（范围：0.71-2.1）]。
结论：特拉维夫议定书，最初开发用于圆锥角膜治疗，是一种安全且有希望的方法，可以阻止手术后扩张进展，同时显着改善视力，从而避免角膜移植术。
