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Debono C, Smadja D, Saunier V, Touboul D. Sequential intracorneal ring segment implantation followed by transepithelial phototherapeutic keratectomy and corneal cross-linking. J Fr Ophtalmol 2022; 45:1117-1125. [DOI: 10.1016/j.jfo.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/05/2022]
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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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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]
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El-Husseiny M, Tsintarakis T, Eppig T, Langenbucher A, Seitz B. [Intacsintracorneal ring segments in keratoconus]. Ophthalmologe 2014; 110:823-6, 828-9. [PMID: 24137764 DOI: 10.1007/s00347-013-2821-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The spectrum of stage-related therapy of keratoconus has been broadened through surgical implantation of intracorneal ring segments (INTACS) as a possible method of reducing irregular astigmatism, leading to a reduction of corneal grafts especially in young, working-aged patients with keratoconus. The purpose of the present study was to evaluate the preoperative and postoperative results of femtosecond laser-assisted implantation of INTACS in ectatic corneal diseases. PATIENTS AND METHODS From August 2011 to January 2013, 20 eyes from 16 patients with a clear cornea in the visual axis suffering from hard contact lens intolerance underwent surgery in the Homburg/Saar Keratoconus Center (HKC) by the same surgeon (MEH). Among these were 16 keratoconus eyes, 1 eye with pellucid marginal degeneration und 3 eyes with post-LASIK iatrogenic keratectasia. The insertion of the INTACS ring segments was achieved by a femtosecond laser-assisted procedure that created a precise 360° tunnel at a depth of 80% of the corneal thickness (395.8 ± 38.5 μm) in the 6–7 mm zone.Results. At 6 months follow-up mean uncorrected distance visual acuity improved from 0.07 ± 0.07 preoperatively to 0.6 ± 0.26 postoperatively. Mean best-corrected distance visual acuity changed from 0.4 ± 0.15 preoperatively to 0.9 ± 0.29 postoperatively. Mean sphere decreased from −7.6 ± 6.1 dpt to −1.4 ± 2.8 dpt. Astigmatism decreased from −6.0 ± 2.8 dpt preoperatively to −4.3 ± 2.0 dpt postoperatively. There was also a reduction in the mean flat K from 47.8 ± 4.7 dpt preoperatively to 44.2 ± 5.0 dpt postoperatively and in mean steep K from 51.9 ± 5.0 dpt to 48.4 ± 6.6 dpt. The central eccentricity index in the Pentacam was reduced to around 50%. Neither intraoperative nor postoperative complications (including non-responders) were observed. CONCLUSIONS The femtosecond laser-assisted INTACS implantation provides a valid alternative to early keratoplasty for keratoconus patients with a clear central cornea and contact lens intolerance. It is a minimally invasive and reliable method for stage-related surgical management of keratoconus.
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Affiliation(s)
- M El-Husseiny
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, UKS, Homburg/Saar.
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