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Alejandre N, Pérez-Merino P, Velarde G, Jiménez-Alfaro I, Marcos S. Optical Evaluation of Intracorneal Ring Segment Surgery in Keratoconus. Transl Vis Sci Technol 2022; 11:19. [PMID: 35289835 PMCID: PMC8934543 DOI: 10.1167/tvst.11.3.19] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to assess the impact of different intracorneal ring segments (ICRS) combinations on corneal morphology and visual performance on patients with keratoconus. Methods A total of 124 eyes from 96 patients who underwent ICRS surgery were analyzed and classified into 7 groups based on ICRS disposition and the diameter of the surgical zone (5- and 6-mm). Pre- and postoperative complete ophthalmological examinations were conducted. Corneal geometry, volume, and symmetry were studied. Zernike polynomials were used to build a virtual ray-tracing model to evaluate optical aberrations and the Visual Strehl (VS). Results ICRS induced significant flattening across the cornea, being more pronounced on the anterior (+0.38 mm, P < 0.001) than on the posterior (+0.15 mm, P < 0.001) corneal radius. Asphericity experienced a larger change for a 6-mm surgical zone diameter (from −1.23 ± 1.1 to −1.86 ± 1.2, P < 0.001) than for a 5-mm zone (from −1.99 ± 1.1 to −2.10 ± 1.5, P = 0.536). Mean astigmatism was reduced by 2.05 D (P < 0.001). Combination four was the most effective in reducing astigmatism. Coma decreased by 30% on average and combination one produced an average reduction by 51% (P < 0.05). Patients experienced significant improvement in visual performance, best corrected visual acuity increased from 0.57 ± 0.21 to 0.69 ± 0.21 and VS changed from 0.049 ± 0.02 to 0.065 ± 0.041. Conclusions ICRS combinations implanted within 5 mm diameter zone are more effective in flattening the cornea, whereas those implanted on 6 mm diameter are as effective in reducing astigmatism and are a good choice if the asymmetry and the intended flattening are smaller. Combinations with asymmetrical implants are the best option to regularize corneal surface. Translational Relevance This study uses methods and metrics of optical research applied to daily clinical practice.
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Affiliation(s)
- Nicolas Alejandre
- Ophthalmology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Pablo Pérez-Merino
- Centre for Microsystems Technology (CMST), Ghent University and Imec, Technologiepark, Ghent, Belgium
| | - Gonzalo Velarde
- Ophthalmology Department, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | - Susana Marcos
- Instituto de Óptica "Daza de Valdés", Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain.,Center for Visual Science, The Institute of Optics, Flaum Eye Institute, University of Rochester, Rochester, New York, USA
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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.
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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
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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.
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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.
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Chonsui M, Touboul D. [Management of a case of post-LASIK ectasia]. J Fr Ophtalmol 2020; 44:e153-e155. [PMID: 33390254 DOI: 10.1016/j.jfo.2020.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/01/2022]
Affiliation(s)
- M Chonsui
- Centre de référence national du kératocône, CRNK, centre François-Xavier Michelet, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - D Touboul
- Centre de référence national du kératocône, CRNK, centre François-Xavier Michelet, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
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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]
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Benoist d'Azy C, Pereira B, Chiambaretta F, Dutheil F. Efficacy of Different Procedures of Intra-Corneal Ring Segment Implantation in Keratoconus: a Systematic Review and Meta-Analysis. Transl Vis Sci Technol 2019; 8:38. [PMID: 31211003 PMCID: PMC6561134 DOI: 10.1167/tvst.8.3.38] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/27/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the efficacy of the functional, keratometric, and refractive postoperative parameters of intracorneal ring segment (ICRS) implantation in keratoconus and its association with collagen cross-linking (CXL), photorefractive keratectomy (PRK), and intraocular lenses (IOLs). Methods We conducted a systematic review and meta-analysis on case series published between 2007 and 2017. Results We included 95 case series with a total of 4560 patients. We included 64 studies of the ICRS procedure, 20 studies of ICRS+CXL, 9 studies of ICRS+CXL+PRK, and 5 studies of ICRS+IOL. We demonstrated an overall improvement of all parameters in all procedures. Cylinder was decreased with an overall effect size (ES) of −1.15 (−1.36 to −0.95; I2 = 93.7%). Corrected distance visual acuity was improved with an overall ES of 0.89 (0.78 to 1.00; I2 = 81.9%). Maximal keratometry was decreased with an overall ES of 0.98 (0.85 to 1.11; I2 = 78.9%). ICRS+IOL is the best procedure to improve spherical equivalent and uncorrected distance visual acuity (P < 0.05) compared with other procedures. ICRSs versus ICRS+CXL are similar in all parameters except for corrected distance visual acuity. ICRS+CXL+PRK is better than ICRS alone in all parameters except for the correction of spherical equivalent. Conclusions Although the quality and strength of the data are questionable, ICRS implantation is an effective strategy to preserve visual function in keratoconic patients. Particularly, ICRS+CXL+PRK could be a low invasive procedure to propose to young keratoconic patients. Translational Relevance To propose an overview of postoperative parameters on each ICRS procedure on keratoconus.
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Affiliation(s)
- Cédric Benoist d'Azy
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Ophthalmology, Preventive and Occupational Medicine, Clermont-Ferrand, France
| | - Bruno Pereira
- University Hospital of Clermont-Ferrand (CHU), Biostatistics Unit, Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Frédéric Chiambaretta
- University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Clermont Auvergne University, CNRS, LaPSCo, Physiological and Psychosocial Stress, University Hospital of Clermont-Ferrand, CHU Clermont-Ferrand, Preventive and Occupational Medicine, WittyFit, Clermont-Ferrand, France.,Australian Catholic University, Faculty of Health, School of Exercise Science, Melbourne, Victoria, Australia
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Fernández-Vega-Cueto L, Lisa C, Poo-López A, Alfonso JF, Madrid-Costa D. Three-year follow-up of intrastromal corneal ring segment implantation in central keratoconus with regular astigmatism: ‘Bow-tie’ shape. Eur J Ophthalmol 2019; 30:643-649. [DOI: 10.1177/1120672119835397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To assess the outcomes of implanting Ferrara-type intrastromal corneal ring segments in central ‘bow-tie’-shaped keratoconus over 3 years of follow-up. Methods: A total of 20 eyes with central ‘bow-tie’-shaped keratoconus were evaluated before and after implanting Ferrara-type intrastromal corneal ring segments (AJL Ophthalmic, Spain). LogMAR uncorrected distance visual acuity and best corrected distance visual acuity and residual refractive errors analysed using vector analysis were recorded preoperatively, at 6 months, 1 year, and 3 years postoperatively. Results: The mean uncorrected distance visual acuity (LogMAR scale) rose from a preoperative 0.75 ± 0.28 to a 6-month postoperative 0.38 ± 0.28 (p < 0.0001). The corrected distance visual acuity, in turn, improved from 0.07 ± 0.06 to 0.05 ± 0.06 (p = 0.0008). Both the uncorrected distance visual acuity and corrected distance visual acuity were stable over the postoperative period in both groups (p > 0.05). None of the eyes lost uncorrected distance visual acuity and corrected distance visual acuity lines over the postoperative follow-up period. The spherical equivalent and the refractive cylinder declined steeply after intrastromal corneal ring segments implantation (p < 0.0001). Both the spherical equivalent and refractive cylinder were stable over the postoperative period. None of the eyes had an increase in maximum or minimum keratometry greater than 0.75D over the postoperative period. Conclusion: The planning for intrastromal corneal ring segments insertion proposed in this study reduces the spherical equivalent and refractive cylinder in this type of keratoconus, while improving post-surgery uncorrected distance visual acuity and corrected distance visual acuity. These results remain stable over 3 years of follow-up. Therefore, this procedure could be considered as an effective therapeutic alternative in patients affected by this type of keratoconus.
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Affiliation(s)
| | - Carlos Lisa
- Fernández-Vega Ophthalmological Institute, Oviedo, Spain
| | | | - José F Alfonso
- Fernández-Vega Ophthalmological Institute, Oviedo, Spain
| | - David Madrid-Costa
- Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
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Garcia-Ferrer FJ, Akpek EK, Amescua G, Farid M, Lin A, Rhee MK, Varu DM, Musch DC, Mah FS, Dunn SP. Corneal Ectasia Preferred Practice Pattern®. Ophthalmology 2019; 126:P170-P215. [DOI: 10.1016/j.ophtha.2018.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023] Open
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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]
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Anterior Segment Changes After Femtosecond Laser-Assisted Implantation of a 355-Degree Intrastromal Corneal Ring Segment in Advanced Keratoconus. Cornea 2018; 37:1438-1443. [DOI: 10.1097/ico.0000000000001702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality. J Ophthalmol 2017; 2017:7589816. [PMID: 29403662 PMCID: PMC5748308 DOI: 10.1155/2017/7589816] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/28/2017] [Indexed: 01/14/2023] Open
Abstract
Keratoconus provides a decrease of quality of life to the patients who suffer from it. The treatment used as well as the method to correct the refractive error of these patients may influence on the impact of the disease on their quality of life. The purpose of this review is to describe the evidence about the conservative surgical treatment for keratoconus aiming to therapeutic and refractive effect. The visual rehabilitation for keratoconic corneas requires addressing three concerns: halting the ectatic process, improving corneal shape, and minimizing the residual refractive error. Cross-linking can halt the disease progression, intrastromal corneal ring segments can improve the corneal shape and hence the visual quality and reduce the refractive error, PRK can correct mild-moderate refractive error, and intraocular lenses can correct from low to high refractive error associated with keratoconus. Any of these surgical options can be performed alone or combined with the other techniques depending on what the case requires. Although it could be considered that the surgical option for the refracto-therapeutic treatment of the keratoconus is a reality, controlled, randomized studies with larger cohorts and longer follow-up periods are needed to determine which refractive procedure and/or sequence are most suitable for each case.
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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]
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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]
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Giacomin NT, Mello GR, Medeiros CS, Kiliç A, Serpe CC, Almeida HG, Kara-Junior N, Santhiago MR. Intracorneal Ring Segments Implantation for Corneal Ectasia. J Refract Surg 2016; 32:829-839. [DOI: 10.3928/1081597x-20160822-01] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/05/2016] [Indexed: 12/20/2022]
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Torquetti L, Arce C, Merayo-Lloves J, Ferrara G, Ferrara P, Signorelli B, Signorelli A. Evaluation of anterior and posterior surfaces of the cornea using a dual Scheimpflug analyzer in keratoconus patients implanted with intrastromal corneal ring segments. Int J Ophthalmol 2016; 9:1283-8. [PMID: 27672592 DOI: 10.18240/ijo.2016.09.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 09/25/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate corneal parameters measured with a dual Scheimpflug analyzer in keratoconus patients implanted with intrastromal corneal ring segments (ICRS). METHODS Fifty eyes of 40 keratoconus patients had Ferrara ICRS implantation from November 2010 to April 2014. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, keratometry, asphericity, elevation, pachymetry, root mean square (RMS), spherical aberration and coma were studied. All patients were evaluated using a dual Scheimpflug system. RESULTS The mean follow-up time after the procedure was 12.7mo. The mean UCVA improved from 0.82 to 0.31 (P<0.001); the mean BCVA improved from 0.42 to 0.05 (P<0.0001), the mean spherical refraction changed from -3.06±3.80 D to -0.80±2.5 D (P<0.0001) and the mean refraction astigmatism reduced from -4.51±2.08 D to -2.26±1.18 D (P<0.0001). The changes from preoperative to postoperative, in parameters of the anterior and posterior surface of the cornea, were statistically significant except the elevation posterior at the apex of the cornea and posterior asphericity. CONCLUSION The implantation of Ferrara ICRS induces changes in both anterior and posterior surfaces of the cornea.
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Affiliation(s)
- Leonardo Torquetti
- Center for Excellence in Ophthalmology, Pará de Minas 35660-051, Brazil; Arce Clinic, Campinas 13106-028, Brazil
| | | | | | | | - Paulo Ferrara
- Paulo Ferrara Eye Clinic, Belo Horizonte 30110-921, Brazil
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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.
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Rho CR, Na KS, Yoo YS, Pandey C, Park CW, Joo CK. Changes in Anterior and Posterior Corneal Parameters in Patients with Keratoconus After Intrastromal Corneal-ring Segment Implantation. Curr Eye Res 2013; 38:843-50. [DOI: 10.3109/02713683.2013.788723] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ferrara G, Torquetti L, Ferrara P, Merayo-Lloves J. Intrastromal corneal ring segments: visual outcomes from a large case series. Clin Exp Ophthalmol 2012; 40:433-9. [DOI: 10.1111/j.1442-9071.2011.02698.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gorgun E, Kucumen RB, Yenerel NM, Ciftci F. Assessment of Intrastromal Corneal Ring Segment Position With Anterior Segment Optical Coherence Tomography. Ophthalmic Surg Lasers Imaging Retina 2012; 43:214-21. [DOI: 10.3928/15428877-20120301-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 02/01/2012] [Indexed: 11/20/2022]
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Moshirfar M, Hsu M, Khalifa YM. Surgical technique: coupling of intrastromal corneal ring segments for ectatic corneal disorders in eye bank corneas. Clin Ophthalmol 2011; 5:1439-42. [PMID: 22034567 PMCID: PMC3198421 DOI: 10.2147/opth.s25000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The management of corneal ectasia is evolving, with intrastromal corneal ring segments playing an important role in delaying or eliminating the need for penetrating keratoplasty. This paper describes a modification in the implantation technique of intrastromal corneal ring segments that allows for coupling of the two segments with suture, affording more structural support.
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Ancèle E, Malecaze F, Arné JL, Fournié P. Facteurs prédictifs de succès des anneaux intracornéens de Ferrara dans le kératocône. J Fr Ophtalmol 2011; 34:513-20. [DOI: 10.1016/j.jfo.2011.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 02/06/2011] [Accepted: 02/14/2011] [Indexed: 11/16/2022]
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Espandar L, Meyer J. Keratoconus: overview and update on treatment. Middle East Afr J Ophthalmol 2011; 17:15-20. [PMID: 20543932 PMCID: PMC2880369 DOI: 10.4103/0974-9233.61212] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Keratoconus is a non-inflammatory, progressive thinning process of the cornea. It is a relatively common disorder of unknown etiology that can involve each layer of the cornea and often leads to high myopia and astigmatism. Computer- assisted corneal topography devices are valuable diagnostic tools for the diagnosis of subclinical keratoconus and for tracking the progression of the disease. The traditional conservative management of keratoconus begins with spectacle correction and contact lenses. Several newer, more invasive, treatments are currently available, especially for contact lens-intolerant patients. Intrastromal corneal ring segments can be used to reshape the abnormal cornea to improve the topographic abnormalities and visual acuity. Phakic intraocular lenses such as iris-fixated, angle-supported, posterior chamber implantable collamer and toric lenses are additional valuable options for the correction of refractive error. Corneal cross-linking is a relatively new method of stiffening the cornea to halt the progression of the disease. The future management of keratoconus will most likely incorporate multiple treatment modalities, both simultaneous and sequential, for the prevention and treatment of this disease.
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Affiliation(s)
- Ladan Espandar
- Department of Ophthalmology, Tulane University, New Orleans, LA, USA
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Abstract
PURPOSE OF REVIEW To review the most recent management strategies for corneal ectasia after keratorefractive surgery. RECENT FINDINGS Management options for postoperative ectasia include conservative management with various types of contact lenses such as rigid gas permeable lenses, custom wave front-guided soft contact lenses, hybrid lenses and tandem soft contact lens-rigid gas permeable lenses. Minimally invasive surgical options including corneal ring segment implantation with Intacs, KeraRings or Ferrara rings have shown to have good results in the initial period after insertion. However, there appears to be some evidence that this initial effect may regress with time. Collagen cross-linking is also minimally invasive and has been documented to stop the progression of ectasia and in some cases may cause regression. Recently, techniques combining collagen cross-linking with intracorneal ring segments or with topography-guided excimer laser treatments have shown to have promising results. SUMMARY Early management of ectasia is essential to prevent its progression and to preserve visual potential. There are several management options that are available that may be used to reduce the need for corneal transplantation for these patients.
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Kubaloglu A, Sari ES, Cinar Y, Koytak A, Kurnaz E, Piñero DP, Ozerturk Y. A single 210-degree arc length intrastromal corneal ring implantation for the management of pellucid marginal corneal degeneration. Am J Ophthalmol 2010; 150:185-192.e1. [PMID: 20570241 DOI: 10.1016/j.ajo.2010.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 03/08/2010] [Accepted: 03/10/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the visual and refractive outcomes of 210-degree arc length intrastromal corneal ring segment (ICRS) implantation in eyes with pellucid marginal corneal degeneration (PMCD). DESIGN Retrospective, consecutive case series. METHODS Sixteen consecutive eyes of 10 patients who underwent a single 210-degree ICRS implantation by femtosecond laser for the management of PMCD and completed at least 1 year follow-up were included. A complete ophthalmic examination was performed preoperatively and postoperatively, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest spherical and cylindrical refractions, spherical equivalent, and keratometric readings. RESULTS The mean follow-up period was 30.7 months (range 12 to 36 months). No intraoperative complication was observed. White deposits around the segments were noted in 2 of 16 eyes (12.5%) at the first postoperative year. The mean UCVA showed significant improvement, from 1.69 +/- 1.02 logarithm of the minimal angle of resolution (logMAR) preoperatively to 0.64 +/- 0.43 logMAR at the 36th month (n = 11, P < .001). The mean preoperative BSCVA was 0.88 +/- 0.68 logMAR; after 36 months, this improved to 0.35 +/- 0.34 (P < .001). At the 36th month, UCVA was improved in all eyes (n = 11, range: gain of 1 to 6 lines), whereas BSCVA was improved in 9 eyes (81.8%, range: gain of 2 to 7 lines) and remained unchanged in 2 eyes (18.1%); UCVA was 20/40 or better in 3 eyes (27%) and BSCVA was 20/40 or better in 8 eyes (72.7%). There was a significant reduction in the spherical equivalent refractive error, from -4.40 +/- 1.85 diopters (D) preoperatively to -1.86 +/- 0.60 D (P < .001), and the mean maximum keratometric power decreased from 49.70 +/- 4.32 D to 46.08 +/- 2.84 D (P < .001) after 36 months. The mean cylindrical refraction decreased from -4.39 +/- 1.86 D preoperatively to -2.38 +/- 1.35 D at 36 months (P < .001). CONCLUSION A single 210-degree arc length ICRS implantation using a femtosecond laser for patients with PMCD provides good visual and refractive outcomes.
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Affiliation(s)
- Anil Kubaloglu
- Dr Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Current world literature. Refractive surgery. Corneal and external disorders. Curr Opin Ophthalmol 2010; 21:322-6. [PMID: 20548165 DOI: 10.1097/icu.0b013e32833bb58c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Torquetti L, Ferrara P. Intrastromal corneal ring segment implantation for ectasia after refractive surgery. J Cataract Refract Surg 2010; 36:986-90. [DOI: 10.1016/j.jcrs.2009.12.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 12/10/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
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