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Michael T, Ioannis G, Ferdinardo M, Ioannis A. Endothelium sparing - Air-assisted wedge resection for the treatment of pellucid marginal degeneration. Indian J Ophthalmol 2024; 72:S314-S318. [PMID: 38146974 DOI: 10.4103/ijo.ijo_3033_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/24/2023] [Indexed: 12/27/2023] Open
Abstract
To describe the surgical technique of performing a wedge resection of a 1 mm area of inferior corneal stroma using stromal air injection assisted separation sparring the endothelium in a patient with bilateral Pellucid Marginal Degeneration. 68-year-old male Caucasian advanced, non progressive. A 30G needle on a 1 ml air-filled syringe injects air into the stromal lamellae with the bevel up, leading to stromal emphysema. An MVR blade is used to incise the marked area until clear corneal tissue is seen. The incised areas are separated with a lamellar dissector, and the crescentic area is excised. The lips of the wound are approximated with 10-0 Prolene sutures. This surgical approach leads to adequate management of the Pellucid Marginal Degeneration without injury to the endothelium, ensuring reduced antigenic input and maintenance of the architectural integrity of the eye.
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Affiliation(s)
- Tsatsos Michael
- 2 Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Ophthalmore, Ophthalmic Practice, Thessaloniki, Greece
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Hashemian SJ, Abdolalizadeh P, Ghiasian L, Aghaei H, Hadavandkhani A, Semnani FN, Jafari ME, Hashemian SM, Hashemian MS. Outcomes of a Single-Segment Intrastromal Corneal Ring in Early Keratoconus and Early Pellucid Marginal Degeneration. Int Ophthalmol 2022; 42:2987-2996. [PMID: 35389172 DOI: 10.1007/s10792-022-02284-8] [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] [Received: 04/19/2021] [Accepted: 03/12/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the effect of a single-segment intrastromal corneal ring segment (ICRS; Intacs SK) on early keratoconus (KCN) and pellucid marginal degeneration (PMD). METHODS It is a prospective interventional study. One hundred twenty-four eyes (99 patients) with KCN and 36 eyes (26 patients) with PMD at early stage (the maximum keratometric reading less than 55 diopters) were included to ICRS implantation using femtosecond laser at a tertiary university-based hospital and a private outpatient center. The uncorrected distance and spectacle-corrected visual acuity (UDVA and SCDVA), manifest spherical and cylindrical refractions, and keratometry indices were measured preoperatively and postoperatively, 1 week, 2 and 6 months. RESULTS One week after surgery, significant improvements were observed in UDVA, SCDVA, cylinder and keratometry readings of both KCN and PMD groups (all P < 0.05) with no significant changes afterward. No significant change occurred in the sphere refraction of PMD group (P = 0.10) in contrast to KCN group (P < 0.001). Corneal irregularity of KCN group in central 3 and 5 mm zones increased at 1 week (both P < 0.001) and then started to decrease up to 6 months. However, the corneal irregularity of PMD group had significant reduction only at 1 week in 5-mm zone (P = 0.02) and 2 months in 3-mm zone (P = 0.01) postoperatively. The final efficacy indexes were 1.44 ± 0.71 and 0.87 ± 0.40 in KCN and PMD groups, respectively. CONCLUSION Visual acuity, refractive errors and keratometry values have been improved after one-segment Intacs SK implantation in early KCN and PMD patients.
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Affiliation(s)
- Seyed Javad Hashemian
- Eye Research Center, Eye Department, The Five Senses health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Eye Research Center, Eye Department, The Five Senses health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Ghiasian
- Eye Research Center, Eye Department, The Five Senses health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Hossein Aghaei
- Eye Research Center, Eye Department, The Five Senses health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Hadavandkhani
- Eye Research Center, Eye Department, The Five Senses health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Nadjafi Semnani
- Eye Research Center, Eye Department, The Five Senses health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ebrahim Jafari
- Eye Research Center, Eye Department, The Five Senses health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mahsa Sadat Hashemian
- Eye Research Center, Eye Department, The Five Senses health Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Tabatabaei SA, Soleimani M, Mirghorbani M, Tafti ZF, Rahimi F. Microbial keratitis following intracorneal ring implantation. Clin Exp Optom 2021; 102:35-42. [DOI: 10.1111/cxo.12810] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 04/12/2018] [Accepted: 06/17/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Seyed Ali Tabatabaei
- Ocular Trauma and Emergency Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,
| | - Mohammad Soleimani
- Ocular Trauma and Emergency Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,
| | - Masoud Mirghorbani
- Ocular Trauma and Emergency Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,
| | | | - Firoozeh Rahimi
- Ocular Trauma and Emergency Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,
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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.
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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.
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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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Mojaled Nobari S, Villena C, Jadidi K. Full-Ring Intracorneal Implantation in Corneas With Pellucid Marginal Degeneration. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e28974. [PMID: 26756018 PMCID: PMC4706990 DOI: 10.5812/ircmj.28974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/29/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Keratoconus (KCN) is a progressive, non-inflammatory ectacic disorder characterized by bilateral and asymmetrical conical protrusion of the cornea. MyoRing implantation and Collagen Crosslink (CXL) are two separate effective treatments for all stages of keratoconous. This study wants to show the effect of these treatments combination in patients with moderate and severe keratoconus. OBJECTIVES The aim of this study was to report on the visual and refractive outcomes of corneas with pellucid marginal degeneration following MyoRing implantation (DIOPTEX GmbH). PATIENTS AND METHODS This study included 15 eyes of 15 patients, with an age range from 22 to 49 years old, and pellucid marginal degeneration. An intrastromal corneal ring (MyoRing) was inserted by the means of mechanical dissection using a PocketMaker microkeratome. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and keratometry readings. The mean postoperative follow-up was ten months (range 6 - 12 months). RESULTS The mean UDVA (LogMAR) improved significantly from 1.13 ± 0.21 preoperatively to 0.24 ± 0.13 postoperatively (P < 0.001), and the mean CDVA (LogMAR) improved significantly from 0.39 ± 0.12 to 0.19 ± 0.09 (P < 0.001). The mean cylinder of manifest refraction decreased significantly by 4.00 diopter (D) (P < 0.001). The mean spherical equivalent error (SE) decreased significantly from -6.00 ± 3.60 D to -0.70 ± 1.90 D, at the end of the follow-up period. Furthermore, with regards to corneal topography, a significant reduction was observed in keratometric values. The Kmax, Kmin and Kaverage decreased significantly by 5.00, 1.10 and 4.00 D, respectively (P < 0.001). CONCLUSIONS MyoRing implantation using the PocketMaker microkeratome appears to provide an effective method for treating pellucid marginal degeneration. Both UDVA and CDVA improved significantly. The corneal steepening and astigmatism were reduced in all subjects after MyoRing implantation.
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Affiliation(s)
- Sahar Mojaled Nobari
- Department of Optics II (Optometry and Vision), Complutense University, Madrid, Spain
| | - Consuelo Villena
- Department of Optics II (Optometry and Vision), Complutense University, Madrid, Spain
| | - Khosrow Jadidi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, IR Iran
- Corresponding Author: Khosrow Jadidi, Bina Eye Hospital Research Center, Tehran, IR Iran. Tel: +98-9121053475, Fax: +98-2122528042, E-mail:
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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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Kymionis GD, Grentzelos MA, Plaka AD, Tsoulnaras KI, Kankariya VP, Shehadeh MM, Pallikaris IG. Simultaneous Conventional Photorefractive Keratectomy and Corneal Collagen Cross-linking for Pellucid Marginal Corneal Degeneration. J Refract Surg 2014; 30:272-6. [DOI: 10.3928/1081597x-20140320-06] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/02/2014] [Indexed: 11/20/2022]
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Hashemi H, Yazdani-Abyaneh A, Beheshtnejad A, Jabbarvand M, Kheirkhah A, Ghaffary SR. Efficacy of intacs intrastromal corneal ring segment relative to depth of insertion evaluated with anterior segment optical coherence tomography. Middle East Afr J Ophthalmol 2014; 20:234-8. [PMID: 24014988 PMCID: PMC3757634 DOI: 10.4103/0974-9233.114800] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AIM To evaluate the effect of implantation depth of Intacs microthin prescription inserts (Addition Technology Inc, Fremont, California) on visual and topographic outcomes in patients with post- laser-assisted in situ keratomileusis (LASIK) ectasias. SETTINGS AND DESIGN Retrospective, observational case series. MATERIALS AND METHODS In this case series, 16 eyes of 12 patients were evaluated. All cases were post-LASIK ectasia that had undergone intrastromal corneal ring segment (ICRS) implantation. The planned insertion depth was 70% of stromal thickness using a manual dissector. At least 12 months postoperatively, all eyes underwent Visante (Carl Zeiss Meditec) AS-OCT to determine insertion depth. Cases were categorized into 3 groups based on the measured implantation depth: 40-59% thickness; 60-79% thickness; and ≥80% thickness. Visual, refractive and topographic outcomes were evaluated relative to implantation depth. RESULTS The lowest improvement in the study parameters ocurred when the implantation depth was ≥80%. In this group, uncorrected visual acuity (UCVA) and best spectacle corrected VA (BSCVA) improved less than 0.5 lines. Manifest refractive spherical equivalent (MRSE) and mean keratometry (Km) change was less than 0.5 diopters (D). The greatest improvements were observed with implantation depth of 60-79% where UCVA and BSCVA increased by 4.5 and 2.5 lines respectively, and MRSE and Km changed by approximately 2.00 D. Less improvement was found when ICRS were implanted between 40-59% of stromal thickness. CONCLUSION Implantation of ICRS greater than 80% of stromal thickness may have no effect on visual and topographic status.
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Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran ; Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Corneoplastique incorporates the entire spectrum of Vision corrective surgery including Lasik, premium cataract surgery, corneal surgery, ocular surface surgery and the full range of anterior segment surgery itself in manipulating the optics of every eye towards unaided emmetropia to define each and every eye surgeon as a "Vision Corrective Surgeon". This concept of approaching each case individually and designing vision therewith enables surgeons to correct not only virgin eyes but also approach complex cases and complications with the goal of 20/20 vision. Armed with this holistic approach, eye surgeons can use minimally invasive, aesthetically pleasing and visually focused surgery in single or staged process aiming for each patient's Best Vision Potential (BVP) raising eye surgery itself then to an Art!
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Affiliation(s)
- Arun C Gulani
- Director and Chief Surgeon, Gulani Vision Institute, 8075 Gate Parkway (W), Suite 102, Jacksonville, Florida 32216, USA
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Camoriano GD, Aman-Ullah M, Purba MK, Sun J, Gimbel HV. Toric collagen copolymer phakic intraocular lens to correct myopic astigmatism in eyes with pellucid marginal degeneration. J Cataract Refract Surg 2012; 38:256-61. [DOI: 10.1016/j.jcrs.2011.08.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/12/2011] [Accepted: 08/14/2011] [Indexed: 10/14/2022]
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Belin MW, Asota IM, Ambrosio R, Khachikian SS. What's in a name: keratoconus, pellucid marginal degeneration, and related thinning disorders. Am J Ophthalmol 2011; 152:157-162.e1. [PMID: 21708379 DOI: 10.1016/j.ajo.2011.03.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/19/2011] [Accepted: 03/21/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE To discuss the implications of the current nomenclature and use of current diagnostic modalities on the classification and treatment of pellucid marginal degeneration and keratoconus. DESIGN Perspective analysis of the literature. METHODS Analysis of published reports on the various treatment methods for pellucid marginal degeneration and keratoconus, and the technologies used in these studies to support the diagnosis and classification of these ectatic disorders. RESULTS Many studies exploring the different treatment modalities for pellucid marginal degeneration and keratoconus rely mainly on anterior curvature maps to establish the diagnosis of these ectatic disorders, and either do not utilize or disregard information provided by pachymetric maps and posterior elevation maps. In addition, the interchangeability of the nomenclature used to describe these disorders in the literature makes it even more difficult for the clinician to determine the applicability of the results to their patient population. CONCLUSIONS We propose that future studies minimally include anterior and posterior elevation maps, anterior curvature topography, and full pachymetric maps. This will allow practitioners a better understanding of the study population, and allow them to ascertain when and in whom the treatment modality being explored may be applicable.
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Affiliation(s)
- Michael W Belin
- University of Arizona Department of Ophthalmology & Vision Science, Tucson, AZ 85658-4741, USA.
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Pellucid corneal marginal degeneration: A review. Cont Lens Anterior Eye 2011; 34:56-63. [DOI: 10.1016/j.clae.2010.11.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 11/11/2010] [Accepted: 11/29/2010] [Indexed: 11/21/2022]
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Alio JL, Piñero DP, Daxer A. Clinical outcomes after complete ring implantation in corneal ectasia using the femtosecond technology: a pilot study. Ophthalmology 2011; 118:1282-90. [PMID: 21440940 DOI: 10.1016/j.ophtha.2010.12.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 08/18/2010] [Accepted: 12/12/2010] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the clinical outcomes after implantation of the MyoRing (DIOPTEX GmBH, Linz, Austria) by means of femtosecond laser technology in eyes with corneal ectasia. DESIGN Retrospective, consecutive, nonrandomized, case series. PARTICIPANTS A total of 12 eyes of 11 patients with ages ranging from 17 to 50 years were included. All cases were diagnosed with corneal ectasia according to the standard criteria: 1 case of post-LASIK ectasia and 11 cases of keratoconus. All cases presented with reduced best spectacle-corrected visual acuity, contact lens intolerance or discomfort, and central corneal thickness of more than 350 μm. METHODS MyoRing inserts of 280 μm in thickness and 5 mm in diameter were implanted in all cases into an intrastromal corneal pocket created by means of femtosecond technology. Visual, refractive, corneal topography, and pachymetric changes were evaluated during a 6-month follow-up. In addition, corneal biomechanical changes were evaluated by means of the Ocular Response Analyzer (Reichert, Buffalo, NY). MAIN OUTCOME MEASURES Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, keratometry, corneal asphericity, corneal higher-order aberrations, pachymetry, corneal hysteresis (CH), and corneal resistance factor (CRF). RESULTS A significant improvement in UDVA was observed 1 week after surgery (P=0.001), which was consistent with the significant reduction in sphere (P=0.002) and cylinder (P=0.004). No significant changes were detected in these parameters afterward (P ≥ 0.263). Furthermore, a significant corneal flattening of a mean value of 8.03 diopters (D) was found (P=0.005). This keratometric change was correlated with the magnitude of corneal coma-like aberrations (r=0.830, P=0.003) and the CRF (r=-0.782, P=0.008). In regard to aberrometry, a statistically significant increase in primary spherical aberration was found 1 month after surgery (P=0.001). In addition, a significant reduction in higher-order corneal aberrations was found 3 to 6 months after surgery (P=0.027). Significant corneal thickening was also observed postoperatively in the central, nasal, and temporal areas (P ≤ 0.013). No statistically significant changes were detected (P ≥ 0.176) in corneal biomechanics. Explantation was performed in a very advanced keratoconus because of the extremely poor visual outcome. CONCLUSIONS MyoRing implantation using femtosecond technology in keratoconus allows successful corneal modeling, although the use of large diameters is advisable.
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Affiliation(s)
- Jorge L Alio
- Vissum/Instituto Oftalmológico de Alicante, Spain.
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Belin MW, Khachikian SS, Ambrosio R. The use of intracorneal rings for pellucid marginal degeneration. Am J Ophthalmol 2011; 151:558-9; author reply 559. [PMID: 21335111 DOI: 10.1016/j.ajo.2010.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 09/21/2010] [Accepted: 10/22/2010] [Indexed: 11/28/2022]
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Photorefractive keratectomy followed by same-day corneal collagen crosslinking after intrastromal corneal ring segment implantation for pellucid marginal degeneration. J Cataract Refract Surg 2010; 36:1783-5. [DOI: 10.1016/j.jcrs.2010.06.044] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 05/11/2010] [Accepted: 05/13/2010] [Indexed: 11/23/2022]
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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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Implantation of new intracorneal ring segments after segment explantation for unsuccessful outcomes in eyes with keratoconus. J Cataract Refract Surg 2010; 36:1303-10. [DOI: 10.1016/j.jcrs.2010.02.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 02/02/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
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Piñero DP, Alio JL. Intracorneal ring segments in ectatic corneal disease - a review. Clin Exp Ophthalmol 2010; 38:154-67. [DOI: 10.1111/j.1442-9071.2010.02197.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Piñero DP, Alió JL, El Kady B, Pascual I. Corneal aberrometric and refractive performance of 2 intrastromal corneal ring segment models in early and moderate ectatic disease. J Cataract Refract Surg 2010; 36:102-9. [DOI: 10.1016/j.jcrs.2009.07.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 07/16/2009] [Accepted: 07/22/2009] [Indexed: 11/27/2022]
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Piñero DP, Alio JL, Morbelli H, Uceda-Montanes A, Kady BE, Coskunseven E, Pascual I. Refractive and Corneal Aberrometric Changes after Intracorneal Ring Implantation in Corneas with Pellucid Marginal Degeneration. Ophthalmology 2009; 116:1656-64. [DOI: 10.1016/j.ophtha.2009.06.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 05/26/2009] [Accepted: 06/02/2009] [Indexed: 11/25/2022] Open
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Management of pellucid marginal corneal degeneration with simultaneous customized photorefractive keratectomy and collagen crosslinking. J Cataract Refract Surg 2009; 35:1298-301. [DOI: 10.1016/j.jcrs.2009.03.025] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/23/2009] [Accepted: 03/24/2009] [Indexed: 11/18/2022]
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Kymionis GD, Bouzoukis DI, Haft P, Siganos CS, Yoo S. Intrastromal corneal ring segments for the treatment of irregular astigmatism. EXPERT REVIEW OF OPHTHALMOLOGY 2008. [DOI: 10.1586/17469899.3.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Use of Verisyse/Artisan Phakic Intraocular Lens for the Reduction of Myopia in a Patient With Pellucid Marginal Degeneration. Cornea 2008; 27:241-5. [DOI: 10.1097/ico.0b013e31815b82b6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rodríguez LA, Guillén PB, Benavides MA, Garcia L, Porras D, Daqui-Garay RM. Penetrating keratoplasty versus intrastromal corneal ring segments to correct bilateral corneal ectasia: Preliminary study. J Cataract Refract Surg 2007; 33:488-96. [PMID: 17321401 DOI: 10.1016/j.jcrs.2006.09.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Accepted: 09/26/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the outcomes over time in patients with corneal ectasia pathology treated with intrastromal corneal ring segments (Intacs, Addition Technology, Inc.) in 1 eye and penetrating keratoplasty (PKP) in the other eye. SETTING Clinica de Cornea, Centro Medico Docente La Trinidad, Caracas, Venezuela. METHODS A nonrandomized comparative study and analysis of retrospective data comprised 17 patients who had PKP in 1 eye and Intacs implantation in the other eye. Patients were classified into 2 groups: asymmetric (different grade of keratoconus in each eye) and symmetric (same grade of keratoconus in both eyes). Parameters analyzed included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and keratometry (flat and steep values and astigmatism readings). Follow-up after PKP was at 24 hours and 6 and 24 months and after Intacs implantation, at 24 hours and 3 and 10 months. RESULTS In both groups, UCVA improved and the corneal shape was normal. No patient lost a line of acuity, and BCVA improved in both groups. CONCLUSIONS Eyes with Intacs had a shorter recovery time than eyes having PKP. The eyes with Intacs had no complications. Complications in eyes with PKP included cataract, graft rejection, and elevated intraocular pressure. Thus, Intacs segments may delay or prevent the need for a corneal graft, although longer follow-up is needed.
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Affiliation(s)
- Luis A Rodríguez
- Centro Medico Docente La Trinidad, Avenida Intercomunal, El Hatillo, Caracas, Venezuela.
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Taboureau E, Berthout A, Turut P, Milazzo S. Dégénérescence marginale pellucide compliquée d’un hydrops cornéen aigu spontané. J Fr Ophtalmol 2006; 29:e13. [PMID: 16885886 DOI: 10.1016/s0181-5512(06)73830-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pellucid marginal corneal degeneration (PMCD) is an ectatic corneal disorder characterized by a peripheral, noninflammatory band of thinning of the inferior cornea. This condition often is misdiagnosed with keratoconus, with which it shares several clinical, videotopographic, and histologic aspects. Furthermore, as with keratoconus, hydrops and spontaneous corneal perforation can occur. We report the case of a 56-year-old man with confirmed PMCD, emphasizing the diagnostic approach, the disease follow-up, and its complication in spontaneous acute corneal hydrops. Finally, regarding this case, authors collect the clinical and videotopographic characteristics of PMCD and discuss the different therapeutic options.
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Affiliation(s)
- E Taboureau
- Service d'Ophtalmologie, CHU d'Amiens, Centre Saint Victor, Amiens.
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McAlister JC, Ardjomand N, Ilari L, Mengher LS, Gartry DS. Keratitis after intracorneal ring segment insertion for keratoconus. J Cataract Refract Surg 2006; 32:676-8. [PMID: 16698494 DOI: 10.1016/j.jcrs.2005.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2005] [Indexed: 11/26/2022]
Abstract
We report a case of sterile keratitis after Ferrara intracorneal ring (Ferrara Ophthalmics) implantation into the right cornea of a keratoconus patient who also suffered from atopic blepharoconjunctivitis. The keratitis resolved within a few days after removal of the Ferrara rings. Ocular atopy with sterile keratitis should be considered in the differential diagnosis of keratitis after the insertion of intracorneal ring segments, which can be easily treated by ring removal.
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