1
|
Sara M, Hui A, Yasir M, Peguda HK, Kalaiselvan P, Willcox M. Intrastromal Corneal Ring Implants Associated Bacterial Infections. Curr Eye Res 2024:1-9. [PMID: 38780797 DOI: 10.1080/02713683.2024.2354438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE This study examines the incidence of infection and resistance associated with Intracorneal Ring Segment (ICRS) implantation, a common outpatient surgical treatment for correcting refractive errors and corneal ectatic diseases. Although ICRS procedures are typically safe and reversible, there is a low but notable risk of microbial infections, which require prompt and sometimes invasive treatment. METHODS Three electronic databases, PubMed, Web of Science (WoS), and Scopus, were utilised to search for literature according to PRISMA guidelines to identify infections related to the implantation of ICRS in the cornea between January 2000 and December 2022. RESULTS Gram-positive organisms were involved in 86% of cases: 35.7% S. aureus, 25% coagulase-negative staphylococci species, 17.8% streptococci and 7.1% Nocardia species. Less commonly recorded were Gram-negative bacteria (14%), with Pseudomonas aeruginosa (circa 10%) and Klebsiella pneumonia (4%) being the most common Gram-negative bacteria. In rare cases, fungi have also been reported. ICRS-related bacterial infections can be categorised into early or late onset. Early onset infection typically manifests within the first few weeks after implantation and is often associated with contamination during surgery, unhygienic practices, or inadequate sterilisation techniques. On the other hand, late-onset infection may develop months or even years after the initial procedures and may be associated with persistent bacterial colonisation, secondary infections, or prolonged use of prophylactic antibiotics. S aureus is encountered in both early and late-onset infections, while Nocardia species and K. pneumoniae have generally been reported to occur in late-onset infections. In addition, vision recovery from S. aureus infections tends to be poor compared to other bacterial infections. CONCLUSION S. aureus is a predominant pathogen that often requires surgical intervention with poor outcomes. Early infections result from incision gaps and ring segment rubbing, while late infections are linked to prolonged antibiotic use. Further research is needed on novel antimicrobial ICRS to procure the vision.
Collapse
Affiliation(s)
- Manjulatha Sara
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alex Hui
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Ocular Research and Education, University of Waterloo, Waterloo, Ontario, Canada
| | - Muhammad Yasir
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Hari Kumar Peguda
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Mark Willcox
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Vega A, Alió JL. Criteria for patient selection and indication for intracorneal ring segments in keratoconus. EYE AND VISION (LONDON, ENGLAND) 2024; 11:13. [PMID: 38528633 PMCID: PMC10964652 DOI: 10.1186/s40662-024-00379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/23/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Keratoconus is an ectatic, progressive corneal disorder characterized by alterations in the morphology of the corneal tissue that leads to limitation of visual function of the patient. Intracorneal ring segments (ICRS) are small synthetic devices that are implanted in the corneal stromal in order to regularize the morphology of the tissue therefore improving the visual function and the quality of life of the patients. MAIN TEXT The present narrative review summarizes the main scientific articles developed by the authors in relation to the clinical outcomes and long-term results of ICRS in the treatment of keratoconus. It was found that those patients that benefit the most from this surgical intervention are those that have the most severe form of keratoconus. Additionally, patients with good visual function, those with more than 0.9 in the decimal scale are at risk of losing visual acuity after ICRS implantation. In relation to long-term results, scientific investigations published by the authors demonstrate that ICRS is a stable procedure after long period of time in terms of vision, refraction, and topographic variables in those patients with stable keratoconus. However, in patients with keratoconus and signs of progression, ICRS may not have the capability of halting the progression of the disease. Using artificial intelligence to guide ICRS implantation provide better clinical outcomes and improvement in corneal higher-order aberrations in patients with keratoconus in comparison to those treated using the commercial nomogram of implantation. CONCLUSIONS ICRS is a safe surgical procedure in the treatment of keratoconus. Patients that benefit most from the surgery are those with a significant visual impairment. ICRS should not be considered in patients with good visual function because of the risk of losing lines of vision. Long-term follow-up demonstrate stability of the clinical outcomes in patients with stable keratoconus although ICRS may not have the ability of halting the progression of the disease. New technologies based artificial intelligence improved the indications and the clinical outcomes of keratoconus patients treated with ICRS.
Collapse
Affiliation(s)
- Alfredo Vega
- Grupo Miranza, Alicante, Spain
- Universidad Miguel Hernandez de Elche, Alicante, Spain
- Hospital Virgen de los Lirios de Alcoy, Alicante, Spain
| | - Jorge L Alió
- Grupo Miranza, Alicante, Spain.
- Universidad Miguel Hernandez de Elche, Alicante, Spain.
| |
Collapse
|
3
|
Soares JSB, Chaves LFOB, Torquetti L, Cunha PFDAD, Toledo M, Rocha G, Magacho L. Results of intrastromal corneal ring implantation in advanced keratoconus With the aim of postpoing or avoiding corneal transplantation. Eur J Ophthalmol 2024; 34:71-78. [PMID: 37700603 DOI: 10.1177/11206721231201661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of the surgery of intracorneal ring segment implantation with 320° of arc (320-ICRS) in patients with advanced keratoconus stage IV and maximum keratometry (Kmax) above 60 D. METHODS A prospective, interventional case series study evaluating 25 eyes of 19 patients with keratoconus stage IV and Kmax > 60D in which 320-ICRS were implanted using VisuMax® femtosecond. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometric values (mean - mean-K, flat - K1, and steep - K2), maximum keratometry (Kmax), tomographic astigmatism, refractive astigmatism and asphericity (Q) were assessed preoperatively and at 3, 6 and 12 months after the procedure. RESULTS The UDVA improved from 1.03 ± 0.28 LogMAR (20/200) to 0.54 ± 0.21 LogMAR (20/60), (p < 0.001), the CDVA (with glasses) improved from 0.63 ± 0.29 LogMAR (20/80) to 0.31 ± 0.16 LogMAR (20/40),(p = 0.004), K1 reduced from 54.41 ± 4.46 D to 49.36 ± 4.11 D (p < 0.001), K2 reduced from 61.15 ± 4.37 D to 53.715 ± 4.05 D, (p < 0.001), mean-K reduced from 57.55 ± 4,17 D to 51.44 ± 3,94 D (p < 0.001), Kmax reduced from 69.80 ± 8.20 D to 63.43 ± 6.31 D (p < 0.001) and asphericity (Q) changed from -1.57 ± 0.35 to -0.77 ± 0.56 (p < 0.001). A total of 89.9% patients reached BCVA wearing scleral contact lens 0.2 LogMAR(20/25). CONCLUSION 320-ICRS to treat advanced keratoconus appears to be an efficacious and safe procedure, being a surgical alternative to delay or even prevent corneal transplantation.
Collapse
Affiliation(s)
| | | | - Leonardo Torquetti
- Cornea Department, Center for Excellence in Ophthalmology, Pará de Minas, Brazil
| | | | - Marcia Toledo
- Cornea Department, Center for Reference in Ophthalmology, Federal University of Goiás,Goiânia (GO), Brazil
| | - Guilherme Rocha
- Cornea Department, Brasilia Ophthalmological Hospital; Av. L2 Sul SGAS 607 Módulo G, Brasilia 70.200-670, Brazil
| | - Leopoldo Magacho
- Cornea Department, Center for Reference in Ophthalmology, Federal University of Goiás,Goiânia (GO), Brazil
| |
Collapse
|
4
|
Erdinest N, Wajnsztajn D, London N, Solomon A. Ocular surface inflammation and ectatic corneal disorders. Curr Opin Allergy Clin Immunol 2023; 23:430-437. [PMID: 37490610 DOI: 10.1097/aci.0000000000000935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW Inflammatory mediators are a focus of recent corneal ectasia (CE) research and are a profound, modifiable contributor to CE in general and keratoconus (KC) in particular, opening a path to explore new methods of control. As advanced imaging technology and expanded population screening allow for earlier detection, the possibility of early intervention can profoundly change the prognosis of CE. RECENT FINDINGS Significant increases in the inflammatory mediators and immune components have been observed in the cornea, tear fluid, and blood of ectasia patients, while inflammation dampeners such as vitamin D and their receptors are reduced. Atopy and allergy have a strong association with KC, known to increase itch factors and stimulate eye rubbing, a risk factor in ectasia pathogenesis. Management of atopy or allergic conditions and topical anti-inflammatories has helped stabilize CE disease. SUMMARY Strategies such as monitoring inflammatory factors and using immune or inflammatory modulators, including managing subclinical inflammation, may be clinically beneficial in stabilizing the disease and improving outcomes. The detected factors are biomarkers, but as yet unproven to be sensitive or specific enough to be considered biomarkers for early detection of CE. The establishment of such biomarkers could improve the therapeutic outcome.
Collapse
Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
| | - Denise Wajnsztajn
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
| | | | - Abraham Solomon
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
| |
Collapse
|
5
|
Fournié P, Acquadro M, Touboul D, Cochener B, Chiambaretta F, Muraine M, Borderie V, Bourges JL, Benmedjahed K, Tugaut B, Bernheim D, Bourcier T, Burillon C, David T, Delbosc B, Gain P, Hoffart L, Labetoulle M, Laroche L, Malet F, Orignac I, Robert PY, Thuret G, Vabres B, Malecaze F, Arnould B. Keratoconus and the Impact of Treatment on Patients' Quality of Life: A Qualitative Study. Ophthalmol Ther 2023; 12:1939-1956. [PMID: 37157013 PMCID: PMC10287584 DOI: 10.1007/s40123-023-00717-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023] Open
Abstract
INTRODUCTION Keratoconus has a significant impact on patients' quality of life (QoL), from diagnosis to the advanced stages of the disease. The aim of this research was to identify domains of QoL affected by this disease and its treatment. METHODS Phone interviews were conducted using a semi-structured interview guide, with patients with keratoconus stratified according to their current treatment. A board of keratoconus experts helped identify the guide's main themes. RESULTS Thirty-five patients (rigid contact lenses, n = 9; cross-linking, n = 9; corneal ring implants, n = 8; and corneal transplantation, n = 9) were interviewed by qualitative researchers. Phone interviews revealed several QoL domains affected by the disease and its treatments: "psychological", "social life", "professional life", "financial costs" and "student life". All domains were impacted, independently of the treatment history. Few differences were found between treatment regimens and keratoconus stages. Qualitative analysis enabled the development of a conceptual framework based on Wilson and Cleary's model for patient outcomes common to all patients. This conceptual model describes the relationship between patients' characteristics, their symptoms, their environment, their functional visual impairment and the impact on their QoL. CONCLUSIONS These qualitative findings supported the generation of a questionnaire to evaluate the impact of keratoconus and its treatment on patients' QoL. Cognitive debriefings confirmed its content validity. The questionnaire is applicable for all stages of keratoconus and treatments and may help tracking change over time in regular clinical settings. Psychometric validation is yet to be performed before its use in research and clinical practices.
Collapse
Affiliation(s)
- Pierre Fournié
- CHU Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - David Touboul
- CHU Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | | | | | | | | | | | | | - Diane Bernheim
- CHU Grenoble, Université Grenoble-Alpes, Grenoble, France
| | - Tristan Bourcier
- Hôpitaux Universitaires de Strasbourg (NHC), Université de Strasbourg, Strasbourg, France
| | | | - Thierry David
- CHU Marseille, Université Aix-Marseille, Marseille, France
| | | | - Philippe Gain
- CHU Saint-Etienne, Université Jean Monnet, Saint-Etienne, France
| | | | - Marc Labetoulle
- CHU Bicêtre, APHP, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Laurent Laroche
- Faculté de Médecine Sorbonne Université, Institut de La Vision-Paris, Paris, France
| | | | | | | | - Gilles Thuret
- CHU Saint-Etienne, Université Jean Monnet, Saint-Etienne, France
| | | | | | | |
Collapse
|
6
|
Avetisov SE, Sheludchenko VM, Osipyan GA, Khraystin K, Abukerimova AK, Dzhalili RA. [Long-term outcomes of bandage therapeutic-optical keratoplasty in the treatment of keratoconus]. Vestn Oftalmol 2022; 138:39-46. [PMID: 36288416 DOI: 10.17116/oftalma202213805139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
UNLABELLED Intrastromal keratoplasty has recently been widely used in the surgical treatment of keratoconus (KC). In 2013, a new type of interlamellar keratoplasty operation was developed - bandage therapeutic-optical keratoplasty (BTOK). PURPOSE Evaluation of the long-term outcomes of surgical treatment of stages II and III progressive KC with BTOK technique. MATERIAL AND METHODS The study included 107 patients (126 eyes): group 1 with stage II KC - 78 eyes, 100% of these patients were observed for 1 year, 52 eyes (66%) for 3 years, and 18 eyes (23%) for 5 years; group 2 - 48 eyes with stage III KC, with 100% of them observed for 1 year, 39 eyes (81%) for 3 years, and 12 eyes (25%) - 5 years. All patients received a customized allograft in the form of an intrastromal corneal ring segment (ICRS). RESULTS During the first year after BTOK surgery, the uncorrected and corrected visual acuity (UCVA and CVA) in the first group increased by 0.5±0.04 (p<0.05) and 0.2±0.02 (p<0.05), respectively, in the second group - by 0.46±0.05 (p<0.05) and 0.47±0.05 (p<0.05) due to a decrease in refractive indices in the central 3.0 mm zone. In the first group, mean refraction in the central 3.0 mm zone (Km) was within 45±3.75 (p<0.05), in the second - 48.63±.2 diopters (p<0.05), while maximum refraction in the central 3.0 mm zone (Kmax) decreased from 50.02±2.20 (p<0.05) to 44.61±1.03 diopters (p<0.05) in the first group, from 58.21±3.43 (p<0.05) to 50.45±3.46 diopters (p<0.05) in the second group. The values of UCVA, CVA and refractive indices of the central corneal zone in the first and second groups did not change statistically significantly after three and five years. Minimum corneal thickness in the first group increased from 476.23±13.35 to 485.08±15.80 µm (p<0.05), in the second - from 412.73±38.63 to 422.00±42.25 µm (p<0.05). CONCLUSION BTOK surgery can be used in patients with stages II and III KC to improve the visual functions, strengthen the ectatic cornea and stop the progression of the disease.
Collapse
Affiliation(s)
- S E Avetisov
- Research Institute of Eye Diseases, Moscow, Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - G A Osipyan
- Research Institute of Eye Diseases, Moscow, Russia
| | - Kh Khraystin
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - R A Dzhalili
- Research Institute of Eye Diseases, Moscow, Russia
| |
Collapse
|
7
|
Ferrara Rings for Visual Rehabilitation in Eyes with Keratoconus and Previous Cross-Linking Using the Ferrara Ring Nomogram. Vision (Basel) 2021; 5:vision5040045. [PMID: 34698306 PMCID: PMC8544695 DOI: 10.3390/vision5040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the visual, refractive and tomographic outcomes following the implantation of intrastromal corneal ring segments (ICRS) (Ferrara rings, AJL Ophthalmics, Miñano, Spain) in eyes with a history of keratoconus and corneal cross-linking using the Ferrara ring nomogram. METHODS Retrospective, interventional case series performed at the Corneoplastics Unit, Queen Victoria Hospital, East Grinstead, United Kingdom. RESULTS 21 eyes of 19 patients with a history of keratoconus and prior corneal collagen cross-linking had Ferrara Intrastromal Corneal Ring Segments implanted between December 2015 and October 2017. The number, thickness and length of ring segments was chosen based on the Ferrara ring company nomogram. Mean uncorrected visual acuity (UDVA) improved from 0.88 to 0.52 logMAR (p < 0.001). Mean corrected visual acuity (CDVA) improved from 0.47 to 0.36 logMAR (p = 0.046). The percentage of eyes achieving 20/40 UDVA and CDVA increased from 5% to 38% and from 38% to 67%, respectively. Of the eyes, 52.3% gained at least two lines of CDVA. The spherical equivalent improved from -7.51D to -3.76D (p < 0.001) and the refractive astigmatism magnitude improved from 5.14D to 2.76D (p = 0.004). There were significant improvements in the corneal tomography with mean keratometry (KM) improving from 50.40D (3.53) to 48.24D (3.00) (p = 0.01) and keratometric astigmatism magnitude improving from 5.14D (2.91) to 2.76D (1.67) (p = 0.004). CONCLUSION Insertion of Ferrara rings in keratoconic eyes with a history of prior cross-linking using the company nomogram results in significant improvements in visual, refractive and tomographic outcomes.
Collapse
|
8
|
Fernández J, Peris-Martínez C, Pérez-Rueda A, Hamida Abdelkader SM, Roig-Revert MJ, Piñero DP. Evaluation of a new nomogram for Ferrara ring segment implantation in keratoconus. Int J Ophthalmol 2021; 14:1371-1383. [PMID: 34540613 DOI: 10.18240/ijo.2021.09.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the short-term clinical outcomes of Ferrara rings in keratoconus using an optimized nomogram developed after several years of research and retrospective analysis of clinical data. METHODS This prospective longitudinal non-comparative clinical trial evaluated 88 eyes of 88 patients (age 18-62y) with keratoconus diagnosis from two Spanish centers. Ferrara ring segment (AJL Ophthalmic) implantation was performed in all cases, using the mechanical procedure in 25 eyes (28.4%) and a femtosecond laser-assisted procedure in 63 eyes (71.6%). The ring segments implanted in each case were selected using a new optimized nomogram that considered variables such as anterior corneal asphericity and astigmatism or the discrepancy among astigmatism and coma orientations. Visual, refractive, corneal topographic, aberrometric, and pachymetric changes after surgery were evaluated during a 3-month follow-up. RESULTS The implants induced a significant refractive change as well as an improvement in uncorrected (UDVA) and corrected distance visual acuity (CDVA; P<0.001). Postoperative CDVA of 0.10 logMAR or better was achieved in 28.4% and 46.5% of eyes, respectively. Two eyes (2.3%) lost two or more lines of CDVA whereas a total of 53.5% of eyes gained lines of CDVA. A significant central anterior and posterior corneal flattening was induced (P≤0.003), with a significant reduction of anterior (P<0.001) and posterior corneal astigmatisms (P=0.048), and a change in anterior asphericity (P<0.001). Total primary coma (6 mm pupil) change was also statistically significant (preoperative 3.66±3.04 µm vs postoperative 2.33±2.26 µm, P<0.001). No significant differences were found in the effect of ring segments between cases implanted using the mechanical and femtosecond techniques (P≥0.101). CONCLUSION The implantation of Ferrara rings based on the nomogram evaluated is safe and effective for promoting a visual rehabilitation in keratoconus, with a relevant control of primary coma aberration.
Collapse
Affiliation(s)
- Joaquín Fernández
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almería 04120, Spain.,Department of Ophthalmology, Torrecárdenas Hospital Complex, Almería 04009, Spain
| | - Cristina Peris-Martínez
- Cornea and External Diseases Unit, FISABIO-Oftalmología Médica (FOM), Valencia 46015, Spain.,Aviño Peris Eye Clinic, Valencia 46001, Spain.,Department of Surgery, Ophthalmology, University of Valencia, Valencia 46010, Spain
| | - Antonio Pérez-Rueda
- Department of Ophthalmology, Torrecárdenas Hospital Complex, Almería 04009, Spain
| | | | - María José Roig-Revert
- Cornea and External Diseases Unit, FISABIO-Oftalmología Médica (FOM), Valencia 46015, Spain.,Department of Surgery, Ophthalmology, University of Valencia, Valencia 46010, Spain
| | - David P Piñero
- Department of Optics, Pharmacology, and Anatomy, University of Alicante, Alicante 03690, Spain
| |
Collapse
|
9
|
Corneal transplantation for keratoconus in South Korea. Sci Rep 2021; 11:12580. [PMID: 34131255 PMCID: PMC8206092 DOI: 10.1038/s41598-021-92133-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
This nationwide population-based study investigated the incidence rate of and risk factors for the progression to corneal transplantation in patients with keratoconus in South Korea using claims data from the Health Insurance Review and Assessment service. Among the entire South Korean population, 10,612 patients newly diagnosed with keratoconus between January 2010 and June 2015 were identified and included in the study. During the study period, 124 patients (1.17%) underwent corneal transplantation, with an average follow-up period of 2.97 ± 1.59 years. The incidence rate of corneal transplantation in patients with keratoconus was 4.46 cases per 1000 person-years. The rate of corneal transplantation for keratoconus was relatively low in South Korea compared to other countries. Multivariate Cox regression analysis revealed that male sex (HR 2.37; 95% CI 1.61–3.50; P < 0.001), severe atopic dermatitis (HR 2.32; 95% CI 1.02–5.28; P = 0.044), obstructive sleep apnea (HR 9.78; 95% CI 1.36–70.10; P = 0.023), and intellectual disability (HR 4.48; 95% CI 1.33–15.11; P = 0.016) significantly increased the risk of progression to corneal transplantation. In patients with keratoconus, male sex, severe atopic dermatitis, obstructive sleep apnea, and intellectual disability were associated with an increased risk of corneal transplantation.
Collapse
|
10
|
|
11
|
David C, Kallel S, Trinh L, Goemaere I, Borderie V, Bouheraoua N. [Intracorneal ring segments in keratoconus management]. J Fr Ophtalmol 2021; 44:882-898. [PMID: 33895029 DOI: 10.1016/j.jfo.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022]
Abstract
Intracorneal ring segments (ICRS), used in the management of keratoconus since the 2000s, have enjoyed significant technological development. Various types of ICRS exist, whose arc length, thickness, and diameter can be chosen according to the desired effect on the spherical equivalent, keratometry and asphericity. Individualized implantation strategies, based on each patient's topographic and tomographic pattern, are constantly evolving. The surgical procedure is standardized, and complications remain very rare. Combined procedures (corneal collagen cross-linking and refractive photokeratectomy±topo-guided, phakic and pseudophakic intraocular lenses) are increasingly used and require a good knowledge of the effect of ICRS alone on the keratoconic cornea. The objective of this review is to summarize clinical practices used in the visual rehabilitation of keratoconic patients using the ICRS+- combined procedures.
Collapse
Affiliation(s)
- C David
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France
| | - S Kallel
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France
| | - L Trinh
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France
| | - I Goemaere
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France
| | - V Borderie
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France; Inserm, CNRS, Sorbonne université, institut de la Vision, 17, rue Moreau, 75012 Paris, France
| | - N Bouheraoua
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France; Inserm, CNRS, Sorbonne université, institut de la Vision, 17, rue Moreau, 75012 Paris, France.
| |
Collapse
|
12
|
Utine CA, Özizmirliler D, Kayabaşı M, Günenç Ü. The number of intracorneal ring segments in asymmetric and central cones. EYE AND VISION (LONDON, ENGLAND) 2021; 8:10. [PMID: 33785054 PMCID: PMC8010988 DOI: 10.1186/s40662-021-00234-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/07/2021] [Indexed: 12/03/2022]
Abstract
Background To compare the results of single versus double intracorneal ring segment (ICRS) (KeraRing) implantation in keratoconus with respect to different cone locations. Methods Twenty-two eyes of 18 patients with totally asymmetric cones (20–80% or 0–100% distribution along steep axis) were implanted with single ICRS (Group 1), 38 eyes of 32 patients with central or partially asymmetric cones (50–50% or 40–60% distribution along steep axis) were implanted with double ICRS (Group 2), at a depth of 80% of the site of implantation, in channels created with femtosecond laser device. All patients had uncorrected and corrected distance visual acuities (UDVA and CDVA, respectively) of ≤ 0.3 Snellen lines. Results In both groups, patients had median UDVA and CDVA gain of 3 Snellen lines (P > 0.05). Postoperative improvement in indices of vertical asymmetry and height decentration in Group 1; simulated keratometry, corneal astigmatism and anterior corneal asphericity values in Group 2 were greater (P < 0.05). A total of 10 eyes (45.5%) in Group 1 were recommended double ring implantation by the manufacturer’s nomogram, but underwent single ICRS implantation and achieved visual, refractive, tomographic outcomes comparable to that in Group 2, although corneal cylindrical correction was less and final topographic astigmatism was greater. Conclusion Double ICRS implantation seems to be superior in terms of keratometry, corneal astigmatism and anterior corneal asphericity improvement. Single ICRS implantation in totally asymmetric cones seems to provide satisfactory visual, refractive and tomographic results, similar to double ICRS implantation in central and partially asymmetric cones, by inducing central shift of the cone.
Collapse
Affiliation(s)
- Canan Asli Utine
- Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad, No:1606 Inciraltı Kampusu, Balcova, 35330, Izmir, Turkey. .,Izmir Biomedicine and Genome Center, Izmir, Turkey.
| | - Denizcan Özizmirliler
- Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad, No:1606 Inciraltı Kampusu, Balcova, 35330, Izmir, Turkey
| | - Mustafa Kayabaşı
- Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad, No:1606 Inciraltı Kampusu, Balcova, 35330, Izmir, Turkey
| | - Üzeyir Günenç
- Department of Ophthalmology, Faculty of Medicine, Dokuz Eylul University, Mithatpasa cad, No:1606 Inciraltı Kampusu, Balcova, 35330, Izmir, Turkey
| |
Collapse
|
13
|
Warrak EL, Serhan HA, Ayash JG, Wahab CH, Baban TA, Daoud RC, Sammouh FK. Long-term follow up of intracorneal ring segment implantation in 932 keratoconus eyes. J Fr Ophtalmol 2020; 43:1020-1024. [PMID: 33127181 DOI: 10.1016/j.jfo.2020.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the progression of keratoconus in 932 eyes of 659 patients through visual, refractive and topographic data after intracorneal ring segment (ICRS) implantation. METHODS Retrospective review of 659 patients who underwent ICRS (Intacs®) implantation for keratoconus between September 1997 and November 2017. Demographics, preoperative and postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) in LogMAR, corneal topography parameters (thinnest pachymetry, Kmax), central corneal pachymetry and total follow-up time were evaluated. Statistical analysis was performed using IBM SPSS Statistics 24.0 for windows. RESULTS Nine hundred and thirty-two eyes of 659 patients, with a mean age of 30.41 years (range 11-76 years), were evaluated. Mean total follow up time was 3.02 years. Forty-one eyes had a total follow up of over 10 years. Both UCVA and BCVA improved significantly after ICRS implantation (P<0.01). Only 18 eyes (2.66% of eyes of patients under 35 years of age) were found to have progression of keratoconus based on postoperative topographic data (Mean age 23.00 years, 55.6% female, total follow-up 2 to 10 years) CONCLUSION: ICRS implantation showed long-term improvement and stability in visual and topographic results in a large case series of patients with keratoconus. Only a minimal rate of progression was detected in young patients. However, further prospective studies need to be conducted to better define predictability of postoperative visual outcomes and progression.
Collapse
Affiliation(s)
- E L Warrak
- Department of Ophthalmology, Saint George Hospital - University Medical Center, Beirut, Lebanon.
| | - H A Serhan
- Department of Ophthalmology, Saint George Hospital - University Medical Center, Beirut, Lebanon
| | - J G Ayash
- Department of Ophthalmology, Saint George Hospital - University Medical Center, Beirut, Lebanon
| | - C H Wahab
- Department of Ophthalmology, Saint George Hospital - University Medical Center, Beirut, Lebanon
| | - T A Baban
- Department of Ophthalmology, Saint George Hospital - University Medical Center, Beirut, Lebanon
| | - R C Daoud
- Department of Ophthalmology, Saint George Hospital - University Medical Center, Beirut, Lebanon
| | - F K Sammouh
- Department of Ophthalmology, Saint George Hospital - University Medical Center, Beirut, Lebanon
| |
Collapse
|
14
|
de Araujo BS, Kubo L, Marinho DR, Kwitko S. Keratoconus progression after intrastromal corneal ring segment implantation according to age: 5-year follow-up cohort study. Int Ophthalmol 2020; 40:2847-2854. [DOI: 10.1007/s10792-020-01468-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
|
15
|
Coşkunseven E, Ambrósio R, Smorádková A, Sánchez León F, Sahin O, Kavadarli I, Jankov MR. Visual, refractive and topographic outcomes of progressive thickness intrastromal corneal ring segments for keratoconic eyes. Int Ophthalmol 2020; 40:2835-2844. [PMID: 32535750 DOI: 10.1007/s10792-020-01467-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate one-year visual, refractive, and topographic outcomes of 58 eyes of 53 keratoconus patients who underwent surgery with a progressive thickness intrastromal corneal ring segment (ICRS). METHODS This multi-center, retrospective, observational study evaluates the one-year effects of progressive thickness ICRS implanted in keratoconus patients meeting the inclusion criteria. One or two progressive ICRS were implanted in the selected eyes after creating an intrastromal tunnel with a femtosecond laser. Pre- and postoperative uncorrected distance visual acuity, best-corrected distance visual acuity, manifest refraction (both spherical equivalent and cylindrical refractions), corneal astigmatism, maximum keratometry, corneal thickness, and corneal topography measurements and indices were evaluated. RESULTS In this retrospective case series, 58 eyes of 53 keratoconus patients were included with a follow-up of 12 months. The mean age was 30.89 ± 11.90 years. There were improvements postoperatively in mean values of visual acuities, both uncorrected from 0.71 (preoperatively) to 0.28 (log MAR), and best-corrected from 0.28 to 0.10 (log MAR), mean cylindrical refraction from - 2.35 ± 1.51 to - 4.15 ± 2.23 D, and mean spherical equivalent from - 2.10 ± 2.25 to - 4.64 ± 3.2 D. There was also a reduction in maximal keratometry from 54.21 D preoperatively to 50.93 D postoperatively. CONCLUSION The implantation of the progressive thickness ICRS is an effective and safe method to improve the vision of keratoconic eyes. Corneal stability was maintained at the 12-month mark.
Collapse
|
16
|
Extrusion of Femtosecond Laser-Implanted Intrastromal Corneal Ring Segments in Keratoconic Eyes: Prevalence, Risk Factors, and Clinical Outcomes. J Ophthalmol 2020; 2020:8704219. [PMID: 32318286 PMCID: PMC7152975 DOI: 10.1155/2020/8704219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/07/2020] [Accepted: 03/10/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To evaluate the prevalence, possible risk factors, and clinical results of femtosecond laser implanted intrastromal corneal ring segment (ICRS) extrusion in keratoconic eyes. Patients and Methods. This is a retrospective observational study evaluating 333 eyes of 269 patients who were subjected to femtosecond laser-implanted Keraring ICRS in the Sohag Refractive Center, Sohag, Egypt, from January 2014 to January 2019. The study included eyes with channels created by a femtosecond laser (60 kHz IntraLase femtosecond system; Advanced Medical Optics, Santa Ana, California, USA) with implantation of Keraring intrastromal corneal ring segments (Mediphacos, Belo Horizonte, Brazil). Patient data and causes of Keraring extrusions were identified as being those rings that migrated or showed melting of the cornea with no other reason which required segment removal. Results Seven eyes were found to fit the criteria of ring extrusion (2.1%) out of the 333 eyes which had Keraring implantation. All extruded rings were from patients with keratoconus grade 3, with eccentric cones, and with femtosecond creation of the tunnel. Four eyes belonging to 3 patients (57.1%) had a history of vernal Keratoconjunctivitis, yet they did not show signs of activity at the time of implantation. They reported excessive rubbing just before they presented with conjunctival hyperemia and foreign body sensation. Five eyes (71.4%) showed chronic sun exposure. The mean minimal corneal thickness was 401.85 μm (range 384–420 μm), while the mean maximum keratometry was 61 D (range 55.18–68.96 D). Most of the extruded rings had large arcs. Six eyes had crosslinking (CXL) at the same session of the Keraring implantation. The simultaneous CXL treatment is considered as a possible significant risk factor for ring extrusion. Conclusion ICRS is an effective reversible option for patients with keratoconus who are intolerant to hard contact lenses, yet the choice of cases and ring segments is mandatory for satisfactory results. Moreover, meticulous history taking and examination reduces the incidence of complications including extrusion.
Collapse
|
17
|
Ibares-Frías L, Gallego-Muñoz P, Orive G, Anitua E, Cantalapiedra-Rodríguez R, Merayo-Lloves J, Martínez-García M. Potential Effect of Plasma Rich in Growth Factors-Endoret in Stromal Wound Healing in Additive Surgery. Ophthalmic Res 2019; 63:203-212. [DOI: 10.1159/000501507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
|
18
|
Bautista-Llamas MJ, Sánchez-González MC, López-Izquierdo I, López-Muñoz A, Gargallo-Martínez B, De-Hita-Cantalejo C, Sánchez-González JM. Complications and Explantation Reasons in Intracorneal Ring Segments (ICRS) Implantation: A Systematic Review. J Refract Surg 2019; 35:740-747. [DOI: 10.3928/1081597x-20191010-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/10/2019] [Indexed: 11/20/2022]
|
19
|
Clinical Outcomes of an Asymmetric Model of Intrastromal Corneal Ring Segments for the Correction of Keratoconus. Cornea 2019; 39:155-160. [DOI: 10.1097/ico.0000000000002160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Sakellaris D, Balidis M, Gorou O, Szentmary N, Alexoudis A, Grieshaber MC, Sagri D, Scholl H, Gatzioufas Z. Intracorneal Ring Segment Implantation in the Management of Keratoconus: An Evidence-Based Approach. Ophthalmol Ther 2019; 8:5-14. [PMID: 31605316 PMCID: PMC6789055 DOI: 10.1007/s40123-019-00211-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 01/19/2023] Open
Abstract
Intracorneal ring segment (ICRS) implantation represents a modern, minimally invasive, surgical option for visual improvement in patients with keratoconus. ICRS modify the corneal geometry in a manner that enhances its refractive properties and thereby, they improve visual acuity. It is well-documented that implantation of ICRS decreases the keratometric readings, spherical equivalent and cylinder, reduces high-order aberrations and improves uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCDVA) in patients with keratoconus. Success rate after ICRS implantation is high, depending on appropriate patient selection and adherence to suitable implantation nomograms, and most important, the overall complication rate is very low. This review is summarizing current indications/contra-indications for ICRS implantation, implantation techniques, clinical outcomes and potential complications, shedding light on myths and realities related to this innovative surgical option.
Collapse
Affiliation(s)
| | | | - Olga Gorou
- Ophthalmica Institute, Thessaloniki, Greece
| | - Nora Szentmary
- Department of Ophthalmology, University Clinic Saarland, Homburg, Saarland, Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Antonios Alexoudis
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | | | | | - Hendrik Scholl
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
21
|
Clinical Outcomes of a New Asymmetric Intracorneal Ring Segment for the Treatment of Keratoconus. Cornea 2019; 38:1228-1232. [DOI: 10.1097/ico.0000000000002062] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Monteiro T, Alfonso JF, Freitas R, Franqueira N, Faria-Correira F, Ambrósio R, Madrid-Costa D. Comparison of Complication Rates between Manual and Femtosecond Laser-Assisted Techniques for Intrastromal Corneal Ring Segments Implantation in Keratoconus. Curr Eye Res 2019; 44:1291-1298. [PMID: 31226888 DOI: 10.1080/02713683.2019.1635165] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To compare the incidence of complications between manual and femtosecond-laser assisted surgery for intrastromal corneal ring segments (ICRS) implantation.Material and methods: This study included keratoconus patients who had ICRS implantation using manual dissection and using the femtosecond laser with a minimum follow-up of 12 months. Uncorrected (UDVA) corrected (CDVA) distance visual acuity (CDVA), refraction, corneal topography and aberrometry, pachymetry map and slit-lamp microscopy were assessed before and after surgery.Results: The study included 265 eyes in the manual group and 111 in the femtosecond laser group. In the manual group, there were complications in 48 eyes (18.11%); while in the femtosecond laser 4 eyes had a complication (3.6%). In the manual group, the most frequent complications were ICRS exchange/adjustment for visual and refractive enhancement (25 eyes; 9.43%) and late ICRS spontaneous extrusion (15 eyes; 5.66%). In the manual group, 81.25% of complications were observed during the first 3 years of surgeon's experience. Eyes who suffered a complication had preoperatively higher mean refractive (p = .002) and topographic cylinder (p = .003) and lower UDVA (p = .005) and CDVA (p = .002). After a second surgical procedure for complication management visual, refractive and topographic outcomes significantly improved.Conclusion: Manual mechanical ICRS surgery shows a higher rate of intra- and postoperative mechanical and refractive complications when compared to femtosecond laser assisted technique. The incidence is specially higher during the surgeon's first years of implementation of the technique.
Collapse
Affiliation(s)
- Tiago Monteiro
- Ophthalmology Department, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - José F Alfonso
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, Spain
| | - Rui Freitas
- Ophthalmology Department, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Nuno Franqueira
- Ophthalmology Department, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Fernando Faria-Correira
- Ophthalmology Department, Hospital de Braga, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - David Madrid-Costa
- Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
23
|
Résultats réfractifs et facteurs pronostiques de succès du traitement du kératocône par anneaux intracornéens : étude rétrospective sur 75 yeux. J Fr Ophtalmol 2019; 42:118-126. [DOI: 10.1016/j.jfo.2018.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/03/2018] [Indexed: 11/15/2022]
|
24
|
Mukhtar S, Ambati BK. Pediatric keratoconus: a review of the literature. Int Ophthalmol 2018; 38:2257-2266. [PMID: 28852910 PMCID: PMC5856649 DOI: 10.1007/s10792-017-0699-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the epidemiology and prevalence, rates of progression, difference between adult and pediatric populations, and therapeutic approaches to pediatric keratoconus from documented literature. METHODS A literature search was done on PubMed using key words including pediatric keratoconus, children with keratoconus, adult keratoconus, penetrating keratoplasty, corneal cross-linking and intracorneal ring segments. The literature was reviewed and reported to explore the key epidemiological differences between the pediatric and adult population with regards to presentation and treatment options. RESULTS Pediatric keratoconus is more aggressive than adult keratoconus, which has been explained by structural differences in the cornea between both populations. High rates of progression were documented in pediatric populations. While corneal collagen cross-linking, intracorneal ring segments and penetrating keratoplasties have been used as therapies in the pediatric population, the literature overwhelmingly shows higher rates of failure and progression despite these measures as compared to adults. CONCLUSION Pediatric keratoconus is more aggressive than adult keratoconus, and current therapies used in adults may not be sufficient for the pediatric population.
Collapse
Affiliation(s)
- Sabrina Mukhtar
- School of Medicine, Virginia Commonwealth University, 1201 E. Marshall St., 4th Floor, Richmond, VA, 232983, USA.
| | - Balamurali K Ambati
- Moran Eye Center, University of Utah, 64 Mario Capecchi Dr, Salt Lake City, UT, 84132, USA
| |
Collapse
|
25
|
Torquetti L, Cunha P, Luz A, Kwitko S, Carrion M, Rocha G, Signorelli A, Coscarelli S, Ferrara G, Bicalho F, Neves R, Ferrara P. Clinical Outcomes After Implantation of 320°-Arc Length Intrastromal Corneal Ring Segments in Keratoconus. Cornea 2018; 37:1299-1305. [DOI: 10.1097/ico.0000000000001709] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
26
|
Sadoughi MM, Einollahi B, Veisi AR, Zare M, Sedaghat MR, Roshandel D, Einollahi N, Rezaei J. Femtosecond laser implantation of a 340-degree intrastromal corneal ring segment in keratoconus: Short-term outcomes. J Cataract Refract Surg 2017; 43:1251-1256. [DOI: 10.1016/j.jcrs.2017.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022]
|
27
|
Tognon T, Campos M, Wengrzynovski JP, Barella KA, Pasqualotti A, de Brito Martins LA, dos Santos Forseto A, de Sousa LB. Indications and visual outcomes of intrastromal corneal ring segment implantation in a large patient series. Clinics (Sao Paulo) 2017; 72:370-377. [PMID: 28658437 PMCID: PMC5463252 DOI: 10.6061/clinics/2017(06)07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/17/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES: To describe the indications for and visual outcomes of intrastromal corneal ring segment implantation. METHODS: A large retrospective case-series chart-review study was conducted using Sorocaba Ophthalmological Hospital medical records. This study included 1222 eyes (1196 patients) that were surgically treated between November 2009 and December 2012. The following preoperative data were collected: age, gender, type of medical care and funding source, surgical technique, best-corrected visual acuity, manifest sphere and cylinder refractive error, maximum and minimum central keratometry, and pachymetry measurements of the cornea at the thinnest point and at the ring channel. The postoperative best-corrected visual acuity and patient satisfaction were also determined. The cases were classified into six groups: four keratoconus groups (severe, advanced, moderate and mild), a pellucid marginal degeneration group and a post-graft irregular astigmatism group. This study was approved by the Brazilian Registry of Clinical Trials (UTN number 1111-1182-6181, TRIAL RBR-6S72RF). RESULTS: The age (mean±standard deviation) of the patients was 31.0±10.0 years. The most prevalent pathology was keratoconus (1147 eyes, 93.8%). A correlation was found between ectasia severity and medical assistance (p<0.001), and the most serious cases was treated by the Brazilian public health system. No complications were found in a total of 1155 surgeries, and after surgery, 959 patients were satisfied. Among the 164 dissatisfied patients, the majority failed to show improved best-corrected visual acuity. CONCLUSION: Patients in the public health system underwent surgical intervention for keratoconus later than those with private sources of funding. In the vast majority of operated cases, the patients reported improvements in vision.
Collapse
Affiliation(s)
- Taíse Tognon
- Instituto Penido Burnier, Campinas, SP, BR
- Hospital Oftalmologico de Sorocaba, Sorocaba, SP, BR
- *Corresponding author. E-mail:
| | - Mauro Campos
- Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Adriano Pasqualotti
- Universidade de Passo Fundo, Passo Fundo, RS, BR
- Universidade de Lisboa, Lisboa, Portugal
| | | | - Adriana dos Santos Forseto
- Hospital Oftalmologico de Sorocaba, Sorocaba, SP, BR
- Universidade Federal de Sao Paulo, Sao Paulo, SP, BR
| | | |
Collapse
|
28
|
Abstract
PURPOSE To describe a new technique of femtosecond laser-assisted intracorneal ring segment implantation. METHODS The study included 6 eyes of 5 patients. Software of the LDV Z6 femtosecond laser was modified to create a 110-degree reverse side cut between the corneal surface and incision instead of the conventional 90 degree angle (which changed the angle between the incision and tunnel from conventional 90-70 degrees) and 2 disjointed tunnels separated by 10 degrees arc length at the proximal and distal ends. RESULTS One-year postoperatively, there were no cases of segment extrusion or touch/overlap. Anterior segment optical coherence tomography showed appropriate position of the rings in all eyes postoperatively. Improvement was also found in visual, refractive, keratometric, and asphericity parameters. CONCLUSIONS The results of this pilot study are promising. A comparative prospective study with more eyes and longer follow-up may confirm whether this technique is better than the conventional femtosecond laser-assisted one.
Collapse
|
29
|
Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities. Eye Contact Lens 2017; 43:141-154. [DOI: 10.1097/icl.0000000000000270] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
30
|
Keraring implantation using the Zeiss Visumax femtosecond laser in the management of patients with keratoconus. Eye (Lond) 2017; 31:916-923. [PMID: 28234352 DOI: 10.1038/eye.2017.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 12/01/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeTo evaluate the safety and efficacy of implanted Kerarings in patients with mild, moderate, and severe keratoconus.Patients and methodsA 12-month retrospective case series of 70 eyes of 70 patients who underwent Keraring implantation with the Zeiss Visumax femtosecond laser. Patients were stratified into three groups according to their topography as mild (mean K <48 D) moderate (48-55 D) or severe (>55 D). Main outcome measures were visual acuity, manifest refraction, and corneal topography. Complications were recorded.ResultsA total of 66 patients completed the 12-month follow-up. In all, 4 rings were explanted, 3 due to no improvement in visual function and 1 due to corneal neovascularization. Also, 4 rings were repositioned. In mild disease (n=28), BCVA increased to 0.10 logMAR, sphere decreased to -1.54 D, cylinder decreased to 2.54 D, Kmax decreased to 46.25 D, and keratometric astigmatism to 3.88 D (P<0.01 for each compared with preoperative values). No patients lost vision. In moderate disease (n=27), sphere decreased to -4.06 D, cylinder decreased to 3.47 D, Kmax decreased to 51.69 D, and keratometric astigmatism to 4.56 D (P<0.05 for each compared with preoperative values). In severe disease (n=11), BCVA increased to 0.34 logMAR, Kmax decreased to 57.65 D, and keratometric astigmatism to 5.07 D (P<0.05 for each compared with preoperative values).ConclusionFemtosecond laser-assisted Keraring implantation is a safe and minimally invasive treatment option to improve the refraction and visual function in patients with keratoconus. Patients with mild keratoconus are more likely to have a favourable outcome following Keraring implantation.
Collapse
|
31
|
Lyra JM, Lyra D, Ribeiro G, Torquetti L, Ferrara P, Machado A. Tomographic Findings After Implantation of Ferrara Intrastromal Corneal Ring Segments in Keratoconus. J Refract Surg 2017; 33:110-115. [DOI: 10.3928/1081597x-20161027-02] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/10/2016] [Indexed: 11/20/2022]
|
32
|
Effects of single-segment Intacs implantation on visual acuity and corneal topographic indices of keratoconus. J Curr Ophthalmol 2017; 29:189-193. [PMID: 28913509 PMCID: PMC5587223 DOI: 10.1016/j.joco.2016.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/27/2016] [Accepted: 10/30/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess the changes in visual acuity and topographic indices after implantation of single-segment Intacs. METHODS Forty-two keratoconic eyes received Femtosecond-assisted single-segment Intacs. Uncorrected distance visual acuity (UDVA) and best spectacle corrected visual acuity (BSCVA), refractive error, keratometry (K1, K2, Km, and KMax.), and seven Pentacam measured topographical indices; 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 minimum radius of curvature (R Min) were assessed 4 months after surgery. Correlations between changes of visual acuity and topographical indices changes were evaluated. RESULTS UDVA increased from 0.92 ± 0.35 to 0.49 ± 0.31 logMAR (P < 0.001), and BSCVA increased from 0.39 ± 0.15 to 0.23 ± 0.11 logMAR (P < 0.001). Subjective refraction spherical equivalent (SRSE) decreased from -3.92 ± 1.66 diopters (D) to -2.00 ± 1.51 D (P < 0.001). Mean central Keratometry decreased 2.16 ± 1.09 D from the preoperative readings (P < 0.001). All Pentacam topographical indices except CKI significantly improved (for IHA P = 0.046, for five others P < 0.001). The correlation between improvement in topographical indices and visual acuity improvements was not week. CONCLUSION Intacs implantation in keratoconic eyes increased visual acuity and made corneal shape less irregular. However, the improvements of visual acuity and corneal shape were not strongly correlated.
Collapse
|
33
|
Ferrara P, Torquetti L, Ferrara G. Intrastromal Corneal Ring Segments in Children with Keratoconus. ACTA ACUST UNITED AC 2017. [DOI: 10.5005/jp-journals-10025-1142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Purpose
To evaluate the long-term follow-up of Ferrara intrastromal corneal ring segments (ICRSs) (Ferrara Ophthalmics, Belo Horizonte, Brazil) implantation for the management of keratoconus in children.
Study design
Paulo Ferrara Eye Clinic, Belo Horizonte, Minas Gerais, Brazil.
Materials and methods
A total of 58 eyes of 37 children with keratoconus were included. One or two ring segments were inserted into the cornea, embracing the keratoconus area. Statistical analysis included preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), asphericity, pachymetry, and keratometry.
Results
Ferrara ICRS implantation significantly improved the mean UDVA and CDVA. Corneal tomography (Pentacam®) showed corneal flattening in all eyes implanted with the Ferrara ring. The mean K decreased, and the corneal asphericity and pachymetry increased in all cases.
Conclusion
The Ferrara ICRS improved all parameters after 2 years of implantation in children with keratoconus. There was significant corneal flattening after ring implantation with improvement of the UDVA and the CDVA. All studied parameters remained stable over time.
How to cite this article
Ferrara G, Ferrara P, Torquetti L. Intrastromal Corneal Ring Segments in Children with Keratoconus. Int J Kerat Ect Cor Dis 2017;6(2):45-48.
Collapse
|
34
|
Heikal MA, Abdelshafy M, Soliman TT, Hamed AM. Refractive and visual outcomes after Keraring intrastromal corneal ring segment implantation for keratoconus assisted by femtosecond laser at 6 months follow-up. Clin Ophthalmol 2016; 11:81-86. [PMID: 28096650 PMCID: PMC5207472 DOI: 10.2147/opth.s120267] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We attempted to evaluate the efficacy of femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus (KC). Patients and methods A retrospective interventional consecutive clinical study was conducted on patients with KC who were treated with femtosecond laser Keraring implantation. All procedures were performed at Ebsar Eye Center in the period from January 5, 2015, to February 28, 2016. Results Thirty eyes of 20 patients were included in this study. The mean age of patients was 27.43±3.57 years. Eleven patients (55%) were female and nine patients (45%) were male. Keraring segments were successfully implanted in all eyes. There were no complications or need for ring repositioning. The follow-up period was 6 months postoperatively. There was a significant improvement in the mean logarithm of the minimum angle of resolution (LogMAR) of uncorrected visual acuity (UCVA) after Keraring segment implantation from 1.5±0.23 preoperatively to 0.54±0.16 at 6 months postoperatively (P=0.001). The preoperative mean LogMAR of best-corrected visual acuity (BCVA) was 0.85±0.17. At 1 month postoperatively, it was 0.35±0.15; at 3 months postoperatively, it was 0.26±0.11, and at 6 months postoperatively, it was 0.14±0.07 (P=0.001). The mean preoperative maximum keratometric value for 3 mm pupil in diopters (K max) significantly decreased from 55.85±5.44 preoperatively (N=30) to 44.05±1.64 D at 6 months postoperatively (P=0.001). There was a statistically significant reduction in the mean preoperative spherical equivalent from −5.43±1.76 D preoperatively to −2.43±0.95 D at 6 months postoperatively. No statistically significant differences were detected between 1 and 3 months of follow-up regarding the visual and refractive outcomes. Conclusion Analysis of the outcomes after Keraring ICRS implantation showed a significant postoperative corneal flattening with a subsequent increase in UCVA and BCVA. Using the femtosecond laser for tunnel creation made the procedure easy and fast with an accurate precise depth of implantation and reduced the risk of operative and postoperative complications.
Collapse
|
35
|
Mid-Term Results of a Single Intrastromal Corneal Ring Segment for Mild to Moderate Progressive Keratoconus. Cornea 2016; 36:530-534. [DOI: 10.1097/ico.0000000000001115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
36
|
Israel M, Yousif MO, Osman NA, Nashed M, Abdelfattah NS. Keratoconus correction using a new model of intrastromal corneal ring segments. J Cataract Refract Surg 2016; 42:444-54. [PMID: 27063526 DOI: 10.1016/j.jcrs.2015.11.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/19/2015] [Accepted: 11/24/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the optical value of a new model of intrastromal corneal ring segments (ICRS) (Keratacx Plus) in patients with keratoconus and to quantify subsequent changes in corneal topography and asphericity. SETTING Private practice. DESIGN Prospective case series. METHODS This study comprised patients who had primary keratoconus or keratectasia after laser in situ keratomileusis (LASIK); none wore contact lenses. Rings were implanted through tunnels created manually or with a femtosecond laser. All eyes had clear visual axes and corneal thickness over 450 μm at the incision site. Preoperative and postoperative pachymetry images were acquired. Results were analyzed using a matched-pair t test and the Kolmogorov-Smirnov test. RESULTS Twenty-nine eyes (24 patients; mean age 30.1 years ± 10.6 [SD]) were evaluated. The ICRS significantly increased uncorrected and corrected visual acuities from 0.05 to 0.16 and from 0.17 to 0.5, respectively (z = 4.7, P < .001). They reduced the median spherical error from -4.0 to -0.5 diopters (D) (P < .001) and median cylindrical error from -4.4 to -2.5 D (P < .001). All topographic parameters were reduced, including maximum keratometry (K) (49.4 D versus 45.1 D), minimum K (49.4 D versus 45.1 D), mean K (51.4 D versus 48.4 D), astigmatism (-2.0 D versus -0.5 D), and asphericity (eccentricity 0.49 versus 0.23) (all P < .001). CONCLUSIONS The ICRS provided topographic and visual improvement in keratoconus and post-LASIK keratectasia. Variance in surgical outcomes with manual versus femtosecond tunneling and the effect of different ring sizes are yet to be studied.
Collapse
Affiliation(s)
- Marina Israel
- From the Department of Ophthalmology (Israel, Yousif, Nashed), Faculty of Medicine, Ain Shams University, Cairo, and the Medical Research Institute (Osman), Alexandria University, Alexandria, Egypt; the Doheny Image Reading Center (Abdelfattah), Doheny Eye Institute, and the Department of Ophthalmology (Abdelfattah), David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Mohamed O Yousif
- From the Department of Ophthalmology (Israel, Yousif, Nashed), Faculty of Medicine, Ain Shams University, Cairo, and the Medical Research Institute (Osman), Alexandria University, Alexandria, Egypt; the Doheny Image Reading Center (Abdelfattah), Doheny Eye Institute, and the Department of Ophthalmology (Abdelfattah), David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Nermin A Osman
- From the Department of Ophthalmology (Israel, Yousif, Nashed), Faculty of Medicine, Ain Shams University, Cairo, and the Medical Research Institute (Osman), Alexandria University, Alexandria, Egypt; the Doheny Image Reading Center (Abdelfattah), Doheny Eye Institute, and the Department of Ophthalmology (Abdelfattah), David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Marina Nashed
- From the Department of Ophthalmology (Israel, Yousif, Nashed), Faculty of Medicine, Ain Shams University, Cairo, and the Medical Research Institute (Osman), Alexandria University, Alexandria, Egypt; the Doheny Image Reading Center (Abdelfattah), Doheny Eye Institute, and the Department of Ophthalmology (Abdelfattah), David Geffen School of Medicine, University of California Los Angeles, California, USA
| | - Nizar S Abdelfattah
- From the Department of Ophthalmology (Israel, Yousif, Nashed), Faculty of Medicine, Ain Shams University, Cairo, and the Medical Research Institute (Osman), Alexandria University, Alexandria, Egypt; the Doheny Image Reading Center (Abdelfattah), Doheny Eye Institute, and the Department of Ophthalmology (Abdelfattah), David Geffen School of Medicine, University of California Los Angeles, California, USA.
| |
Collapse
|
37
|
Gauthier AS, Friot M, Montard R, Saleh M, Delbosc B. Anneaux intra-cornéens Ferrara implantés au laser femtoseconde dans le traitement du kératocône : résultats fonctionnels à 1 an. J Fr Ophtalmol 2016; 39:428-36. [DOI: 10.1016/j.jfo.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022]
|
38
|
Vega-Estrada A, Alio JL. The use of intracorneal ring segments in keratoconus. EYE AND VISION 2016; 3:8. [PMID: 26981548 PMCID: PMC4791885 DOI: 10.1186/s40662-016-0040-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/06/2016] [Indexed: 12/31/2022]
Abstract
Keratoconus is a corneal degeneration that usually appears during puberty and may seriously deteriorate the quality of life of the patients. This corneal disease is today the first indication of corneal transplantation in young patients. Until the last decade of the XX century, keratoplasty procedures were the only alternative to treat this pathological condition. In the beginning of the XXI century, intracorneal ring segments implantation was proposed as a therapeutic choice for treating keratoconus patients. Since then, several published articles have reported the benefits of this surgical procedure in treating this type of corneal ectatic disorder. The purpose of the present investigative work is to summarize the characteristic of the intracorneal ring segments and also to review the different features published in the literature in relation to this surgical technique for the treatment of keratoconus patients.
Collapse
Affiliation(s)
- Alfredo Vega-Estrada
- Keratoconus Unit, Vissum Alicante, Calle Cabañal, 1 Edificio Vissum, 03016 Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge L Alio
- Keratoconus Unit, Vissum Alicante, Calle Cabañal, 1 Edificio Vissum, 03016 Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| |
Collapse
|
39
|
Pashtaev NP, Pozdeeva NA, Sinitsyn MV, Zotov VV, Gagloev BV. [Comparative evaluation of different corneal cross-linking techniques with respect to biomechanical stability of the cornea]. Vestn Oftalmol 2016; 132:38-46. [PMID: 27213796 DOI: 10.17116/oftalma2016132238-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM To perform a comparative analysis of the following cross-linking techniques: standard cross-linking (SCXL), local transepithelial femto cross-linking (LTF) and transepithelial intrastromal femto cross-linking with MyoRing implantation (TIF+MyoRing) in experimental animals and patients with progressive stage II--III keratoconus (KC), paying particular attention to the changes in biomechanical stability of the cornea. MATERIAL AND METHODS The experimental series was performed on 20 eyes of 10 rabbits. The animals were divided into 4 groups of 5. Group 1 served as the control, group 2 consisted of animals that underwent SCXL, group 3 -- of those after LTF, and group 4 -- of those after TIF+MyoRing. Femto step was performed using the IntraLase FS 60 kHz femtosecond laser, cross-linking - with the Evolution machine. The follow-up period was 1 month. Clinical study enrolled 48 patients (45 eyes) with stage II-III KC. Depending on the surgical technique all the patients were divided into 3 groups. In group I (14 eyes, 9 patients), TIF+MyoRing was performed, in group II (16 eyes, 20 patients) --SCXL, in group III (15 eyes, 19 patients) -- LTF. The follow-up period was 6 months. RESULTS The experiment showed a significant increase in rupture resistance of the cornea in all three groups. Six months after surgery, patients from group I demonstrated a 1.0±0.22 mmHg higher corneal resistance factor (CRF) and a 1.0±0.12 mmHg higher corneal hysteresis (CH). In group II, the said parameters increased by 0.8±0.10 mmHg and 0.6±0.16 mmHg, respectively; in group III -- by 0.8±0.25 mmHg and 0.6±0.26 mmHg, respectively. In neither group the density of endothelial cells has reduced significantly over the follow-up period. C-ONCLUSION: All three methods (LTF, TIF and SCXL) equally increase the biomechanical strength of the cornea and are safe. In patients with progressive stage II-III KC, TIF+MyoRing surgery has yielded an even higher improvement of biomechanical parameters in a 6-month follow-up period, which is due to the combination of mechanical and chemical mechanisms of corneal reinforcement.
Collapse
Affiliation(s)
- N P Pashtaev
- Cheboksary branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 10 Traktorostroiteley pr., Cheboksary, Chuvash Republic, Russian Federation, 428028; Postgraduate Doctors' Training Institute, Ministry of Healthcare and Social Development of the Chuvash Republic, 3 Krasnaya Sq., Cheboksary, Chuvash Republic, Russian Federation, 428003; The Chuvash State University named after I.N. Ulyanov, 15 Moskovskiy pr., Cheboksary, Chuvash Republic, Russian Federation, 428010
| | - N A Pozdeeva
- Cheboksary branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 10 Traktorostroiteley pr., Cheboksary, Chuvash Republic, Russian Federation, 428028; Postgraduate Doctors' Training Institute, Ministry of Healthcare and Social Development of the Chuvash Republic, 3 Krasnaya Sq., Cheboksary, Chuvash Republic, Russian Federation, 428003
| | - M V Sinitsyn
- Cheboksary branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 10 Traktorostroiteley pr., Cheboksary, Chuvash Republic, Russian Federation, 428028
| | - V V Zotov
- Cheboksary branch of the Academician S.N. Fyodorov IRTC 'Eye Microsurgery', Ministry of Health of the Russian Federation, 10 Traktorostroiteley pr., Cheboksary, Chuvash Republic, Russian Federation, 428028
| | - B V Gagloev
- Postgraduate Doctors' Training Institute, Ministry of Healthcare and Social Development of the Chuvash Republic, 3 Krasnaya Sq., Cheboksary, Chuvash Republic, Russian Federation, 428003
| |
Collapse
|
40
|
Ibares-Frías L, Gallego P, Cantalapiedra-Rodriguez R, Merayo-Lloves J, Martínez-García MC. Clinical, Refractive and Histological Reversibility of Corneal Additive Surgery in Deep Stroma in an Animal Model. Curr Eye Res 2016; 41:1192-201. [PMID: 26889567 DOI: 10.3109/02713683.2015.1114652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim was to evaluate the reversibility of the clinical and histological changes induced in the corneas of an animal model after removing an intracorneal ring segment (ICRS). METHODS Surgery for this study was performed in 38 eyes of an experimental animal model (Gallus domesticus) for ICRS surgery (Ferrara technique). The animals without complications were randomized to two groups; in all of them, 1 segment was implanted in each eye and later removed at different times (1 and 3 months after implantation). In each group, after explantation, corneas were processed at different times for histological analysis with hematoxylin and eosin (H&E) stain and electronic microscopy. The refractive state of the eyes was also measured. RESULTS In corneas without complications (88.23%), explantation was performed correctly. During the first few days, around the area where the ICRS was implanted we observed deposits of cells and a moderate degree of corneal opacity (haze). These signs decreased progressively without disappearing completely. Histologically, at 7 days, we observed hyperplasia and abnormal arrangement of collagen fibers. Later, these findings also decreased in both groups, albeit at a faster rate in group 1. Minimal changes were observed in electron microscopy up to the end of the study in both groups. Preoperative refractive state was achieved at 1 month after explantation in both groups. CONCLUSIONS ICRS can safely be explanted from the cornea. Refractive reversibility was achieved at 1 month after explantation. However, the clinical and histological findings after ICRS explantation depend on the time from implantation to explantation.
Collapse
Affiliation(s)
- Lucía Ibares-Frías
- a Optical Diagnostic Techniques Group, Theoretical, Atomic and Optical Physics Department , University of Valladolid , Valladolid , Spain.,b Ophthalmology Department , Hospital Clínico Universitario de Valladolid , Valladolid , Spain
| | - Patricia Gallego
- a Optical Diagnostic Techniques Group, Theoretical, Atomic and Optical Physics Department , University of Valladolid , Valladolid , Spain.,c Cell Biology, Histology and Pharmacology Department , Faculty of Medicine, University of Valladolid , Valladolid , Spain
| | | | - Jesús Merayo-Lloves
- a Optical Diagnostic Techniques Group, Theoretical, Atomic and Optical Physics Department , University of Valladolid , Valladolid , Spain.,d Instituto Universitario Fernandez-Vega, Universidad de Oviedo , Oviedo , Spain
| | - María Carmen Martínez-García
- a Optical Diagnostic Techniques Group, Theoretical, Atomic and Optical Physics Department , University of Valladolid , Valladolid , Spain.,c Cell Biology, Histology and Pharmacology Department , Faculty of Medicine, University of Valladolid , Valladolid , Spain
| |
Collapse
|
41
|
Hashemi H, Amanzadeh K, Miraftab M, Asgari S. Femtosecond-assisted intrastromal corneal single-segment ring implantation in patients with keratoconus: a 12-month follow-up. Eye Contact Lens 2016; 41:183-6. [PMID: 25603435 DOI: 10.1097/icl.0000000000000106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine visual rehabilitation in patients with keratoconus who received femtosecond-assisted intrastromal corneal single-segment ring implantation. METHODS This prospective study was conducted on 62 eyes of 45 patients with keratoconus who received single-segment Intacs. The FS200 femtosecond laser was used for tunnel creation. Patients were examined for astigmatism, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and manifest refraction spherical equivalent (MRSE) before the operation and 1, 6, and 12 months after operation. Scheimpflug imaging including minimum keratometry reading (min-K), maximum keratometry reading (max-K), average of minimum and maximum keratometry readings (mean-K), central corneal thickness (CCT), asphericity (Q-value), index of surface variance (ISV), index of vertical asymmetry (IVA), keratoconus index (KI), center keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD), and minimum sagittal curvature (Rmin) was performed before and 12 months after the operation. RESULTS The mean preoperative UCVA was 20/130, which increased to 20/62 1 year after the operation (P < 0.001). The mean BCVA in the last follow-up was 20/32, which improved when compared with preoperative BCVA (20/40) (P = 0.008). One year after the operation, MRSE and cylinder decreased to 1.33 ± 1.90 diopter (D) and 0.46 ± 1.50 D, respectively (P < 0.001 for both). Min-K, max-k, and mean-k reduced to 1.67 ± 0.1.40 D, 2.08 ± 1.84 D, and 1.85 ± 1.30 D (P < 0.001 for all). Q-value decreased to 0.81 ± 1.14 (P < 0.001). In contrast, CKI had a significant increase of 0.02 (P = 0.002). Other evaluated indexes did not show any significant differences. CONCLUSION Implantation of the single-segment ring in patients with keratoconus improved vision because of regularizing the cornea and centralization of the corneal cone.
Collapse
Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center (H.H., K.A., M.M.), Noor Eye Hospital, Tehran, Iran; and Department of Epidemiology and Biostatistics (S.A.), School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
| | | | | | | |
Collapse
|
42
|
Reshaping procedures for the surgical management of corneal ectasia. J Cataract Refract Surg 2015; 41:842-72. [PMID: 25840308 DOI: 10.1016/j.jcrs.2015.03.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 12/31/2022]
Abstract
UNLABELLED Corneal ectasia is a progressive, degenerative, and noninflammatory thinning disorder of the cornea. Recently developed corneal reshaping techniques have expanded the treatment armamentarium available to the corneal specialist by offering effective nontransplant options. This review summarizes the current evidence base for corneal collagen crosslinking, topography-guided photorefractive keratectomy, and intrastromal corneal ring segment implantation for the treatment of corneal ectasia by analyzing the data published between the years 2000 and 2014. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
Collapse
|
43
|
Vega-Estrada A, Alió JL, Plaza-Puche AB. Keratoconus progression after intrastromal corneal ring segment implantation in young patients: Five-year follow-up. J Cataract Refract Surg 2015; 41:1145-52. [DOI: 10.1016/j.jcrs.2014.08.045] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 11/15/2022]
|
44
|
|
45
|
Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
Collapse
Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
| |
Collapse
|
46
|
Outcome of intrastromal corneal ring segment relative to depth of insertion evaluated with scheimpflug image. J Curr Ophthalmol 2015; 27:25-31. [PMID: 27239571 PMCID: PMC4877726 DOI: 10.1016/j.joco.2015.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To report the results of intrastromal corneal ring segment (KeraRing; Mediphcose, Belo Horizonte, Brazil) implantation relative to depth of insertion in keratoconic patients. METHODS In this retrospective, observational study, we evaluated 29 eyes of 27 patients with keratoconus who underwent implantation of KeraRing SI-5 with mechanical tunnel creation. In the mean follow-up of 8.8 months, all eyes underwent scheimpfluge image of pentacam (Oculus, Germany) to determine insertion depth. Based on the measured implantation depth, cases were categorized into: 40-59% thickness group, 60-79% thickness group, and ≥80% thickness group. Visual, refractive, and shape outcomes were evaluated relative to implantation depth. RESULTS The mean insertion depth was 61.7%.We had 41.4% of cases were in the 40-59% thickness group, 51.7% in the 60-79% group, and 6.9% in the >80% group. Results were similar in 40-59% and 60-79% thickness groups: uncorrected visual acuity (UCVA) and best spectacle corrected VA (BSCVA) improved 3 and 2 lines, respectively, maximum keratometry (Kmax) decreased 2.6 D, refractive cylinder improved 2.04 D, and Q value 8 mm anterior changed by 0.35. In the ≥80% thickness group, UCVA and BSCVA improved less than 1 lines, Kmax change was less than 0.5 D, and RC decreased less than 0.25 D. CONCLUSION Implantation of KeraRing with mechanical tunnel creation in 40-80% of stromal thickness despite the variable insertion depth is effective.
Collapse
|
47
|
Intrastromal corneal ring segment implantation (keraring 355°) in patients with central keratoconus: 6-month follow-up. J Ophthalmol 2015; 2015:916385. [PMID: 25685395 PMCID: PMC4313675 DOI: 10.1155/2015/916385] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 11/27/2014] [Accepted: 11/28/2014] [Indexed: 11/17/2022] Open
Abstract
We evaluate the efficacy and safety of Keraring 355° intrastromal corneal ring segment (ICRS) implantation aided by PocketMaker microkeratome for the correction of keratoconus. Patients underwent ICRS insertion using mechanical dissection with PocketMaker microkeratome and completed 6 months of follow-up. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, safety, efficacy index, and adverse events were reported for six months postoperatively. We evaluated 15 eyes of 15 patients (12 men) with a mean age of 28.87 ± 6.94 years (range 21–49 years). At final postoperative examination, there was a statistically significant reduction in the spherical equivalent refractive error compared to preoperative measurements (−5.46 ± 1.52 to −2.01 ± 1.63 D, P < 0.001). Mean preoperative UCVA (logMAR) before implantation was 0.79 ± 0.48, and postoperative UCVA was 0.28 ± 0.15, P = 0.001. Mean preoperative BSCVA (logMAR) before implantation was 0.36 ± 0.21; at final follow-up examination BSCVA was 0.18 ± 0.9, P = 0.009. Mean K decreased from 48.33 to 43.31 D, P < 0.001. All patients were satisfied with ICRS implantation; 86.7% were moderately to very happy with the results. No intraoperative or postoperative complications were demonstrated. This preliminary study shows that ICRS (Keraring 355°) implantation is an efficient, cost-effective, and minimally invasive procedure for improving visual acuity in nipple type keratoconic corneas.
Collapse
|
48
|
Peña-García P, Alió JL, Vega-Estrada A, Barraquer RI. Internal, corneal, and refractive astigmatism as prognostic factors for intrastromal corneal ring segment implantation in mild to moderate keratoconus. J Cataract Refract Surg 2014; 40:1633-44. [DOI: 10.1016/j.jcrs.2014.01.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/18/2013] [Accepted: 01/07/2014] [Indexed: 12/26/2022]
|
49
|
Karamichos D, Hjortdal J. Keratoconus: tissue engineering and biomaterials. J Funct Biomater 2014; 5:111-34. [PMID: 25215423 PMCID: PMC4192608 DOI: 10.3390/jfb5030111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 08/26/2014] [Accepted: 09/03/2014] [Indexed: 12/20/2022] Open
Abstract
Keratoconus (KC) is a bilateral, asymmetric, corneal disorder that is characterized by progressive thinning, steepening, and potential scarring. The prevalence of KC is stated to be 1 in 2000 persons worldwide; however, numbers vary depending on size of the study and regions. KC appears more often in South Asian, Eastern Mediterranean, and North African populations. The cause remains unknown, although a variety of factors have been considered. Genetics, cellular, and mechanical changes have all been reported; however, most of these studies have proven inconclusive. Clearly, the major problem here, like with any other ocular disease, is quality of life and the threat of vision loss. While most KC cases progress until the third or fourth decade, it varies between individuals. Patients may experience periods of several months with significant changes followed by months or years of no change, followed by another period of rapid changes. Despite the major advancements, it is still uncertain how to treat KC at early stages and prevent vision impairment. There are currently limited tissue engineering techniques and/or "smart" biomaterials that can help arrest the progression of KC. This review will focus on current treatments and how biomaterials may hold promise for the future.
Collapse
Affiliation(s)
- Dimitrios Karamichos
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, 608 Stanton L. Young Blvd, DMEI PA-409, Oklahoma City, OK 73104, USA.
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus C DK-800, Denmark.
| |
Collapse
|
50
|
Alio JL, Vega-Estrada A, Esperanza S, Barraquer RI, Teus MA, Murta J. Intrastromal corneal ring segments: how successful is the surgical treatment of keratoconus? Middle East Afr J Ophthalmol 2014; 21:3-9. [PMID: 24669139 PMCID: PMC3959038 DOI: 10.4103/0974-9233.124076] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This review evaluates the outcomes of intrastromal corneal ring segment (ICRS) implantation for the treatment of keratoconus considering a new grading system based on the preoperative visual impairment of the patient. Additionally, a five-year follow-up analysis of patients with stable and progressive keratoconus is performed in order to assess the long term stability of the surgical procedure. Corrected distance visual acuity decreased statistically significantly in patients with mild keratoconus (P < 0.01) but statistically significantly increased in all other grades (P < 0.05). The improvement in visual acuity and the decrease of keratometric and aberrometric values were stable throughout a long period of time in patients with stable keratoconus. In patients with progressive form keratoconus, a significant improvement was found immediately after the procedure, however clinically relevant regression greater than 3 D was observed at the end of the follow up period.
Collapse
Affiliation(s)
- Jorge L Alio
- Keratoconus Unit, Vissum Coorporation, Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Alfredo Vega-Estrada
- Keratoconus Unit, Vissum Coorporation, Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Santiago Esperanza
- Keratoconus Unit, Vissum Coorporation, Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Rafael I Barraquer
- Anterior Segment Department, Centro de Oftalmología Barraquer, Barcelona, Spain
| | - Miguel A Teus
- Anterior Segment Department, Vissum Corporation, Madrid, Spain
| | - Joaquim Murta
- Ophthalmology Department, Coimbra University Hospital, Coimbra, Portugal
| |
Collapse
|