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Ormonde S. Refractive surgery for keratoconus. Clin Exp Optom 2021; 96:173-82. [DOI: 10.1111/cxo.12051] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sue Ormonde
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand,
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Jacobs DS, Carrasquillo KG, Cottrell PD, Fernández-Velázquez FJ, Gil-Cazorla R, Jalbert I, Pucker AD, Riccobono K, Robertson DM, Szczotka-Flynn L, Speedwell L, Stapleton F. CLEAR - Medical use of contact lenses. Cont Lens Anterior Eye 2021; 44:289-329. [PMID: 33775381 DOI: 10.1016/j.clae.2021.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.
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Affiliation(s)
- Deborah S Jacobs
- Massachusetts Eye & Ear, Cornea and Refractive Surgery Service, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Loretta Szczotka-Flynn
- Department of Ophthalmology & Visual Science, Case Western Reserve University, Cleveland, OH, USA
| | - Lynne Speedwell
- Great Ormond Street Hospital for Children NHS Trust, Moorfields Eye Hospital, London, UK
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Scleral lens after intracorneal ring segments in patients with keratoconus. Cont Lens Anterior Eye 2018; 41:234-237. [DOI: 10.1016/j.clae.2017.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
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Sequential intrastromal corneal ring segment and monofocal intraocular lens implantation for keratoconus and cataract: Long-term follow-up. J Cataract Refract Surg 2017; 43:246-254. [DOI: 10.1016/j.jcrs.2016.11.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022]
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Nonsurgical Procedures for Keratoconus Management. J Ophthalmol 2017; 2017:9707650. [PMID: 29430305 PMCID: PMC5753012 DOI: 10.1155/2017/9707650] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives To describe the past 20 years' correction modalities for keratoconus and their visual outcomes and possible complications. Methods A review of the published literature related to the visual outcomes and possible complications in the context of keratoconus management using nonsurgical procedures for the last 20 years (glasses and contact lenses) was performed. Original articles that reported the outcome of any correction modalities of keratoconus management were reviewed. Results The most nonsurgical procedure used on keratoconus management is the contact lens fitting. Soft contact lenses and soft toric contact lenses, rigid gas-permeable contact lenses, piggyback contact lens system, hybrid contact lenses, and scleral and corneoscleral contact lenses form the contemporary range of available lens types for keratoconus management with contact lenses. All of them try to restore the vision, improve the quality of life, and delay surgical procedures in patients with this disease. Complications are derived from the intolerance of using contact lens, and the use of each depends on keratoconus severity. Conclusions In the context of nonsurgical procedures, the use of contact lenses for the management of keratoconic patients represents a good alternative to restore vision and improve the quality of live in this population.
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Alipour F, Rahimi F, Hashemian MN, Ajdarkosh Z, Roohipoor R, Mohebi M. Mini-scleral Contact Lens for Management of Poor Visual Outcomes after Intrastromal Corneal Ring Segments Implantation in Keratoconus. J Ophthalmic Vis Res 2016; 11:252-7. [PMID: 27621780 PMCID: PMC5000525 DOI: 10.4103/2008-322x.188400] [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: 11/12/2022] Open
Abstract
Purpose: To evaluate the feasibility and efficacy of mini-scleral design (MSD) contact lenses to treat keratoconus patients who were unsatisfied with the results of corneal inlay. Methods: In this prospective interventional case series, 9 eyes of 6 keratoconus patients who were unsatisfied with the results of corneal inlay were fitted with MSD contact lenses. Demographic data, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and higher order aberrations (HOAs) were evaluated before contact lens fitting. Corrected visual acuity by placing the MSD contact lens with or without over-refraction, and HOAs were measured one hour after contact lens fitting. One month after contact lens wearing, corrected visual acuity by placing the MSD contact lens with over-refraction and possible contact lens related problems were assessed. Ocular comfort and contact lens handling problems were asked in follow-up visits. The data was analyzed using descriptive statistical tests. Results: Nine eyes of 6 patients were successfully fitted with the mini-scleral lens. Fitting was ideal in 7 eyes and acceptable in 2 eyes. Mean corrected visual acuity by placing the MSD lens without over-refraction was 0.09 (range, 0.00-0.15) LogMAR which was significantly better than the mean BSCVA of 0.38 (range, 0.2-0.6) LogMAR (P = 0.007). The mean root mean square (RMS) of third-order coma and trefoil significantly decreased after MSD contact lens fitting (P = 0.012 and P = 0.015, respectively); however, changes in the fourth-order spherical aberration were not statistically significant (P = 0.336). Conclusion: Mini-scleral contact lenses may be helpful in the management of visually unsatisfied patients after corneal inlay.
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Affiliation(s)
- Fatemeh Alipour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Firoozeh Rahimi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Ajdarkosh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramak Roohipoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Mohebi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Use of Wavefront Imaging Technology to Demonstrate Improvement in Corneal Aberrations Using Piggyback Contact Lens in a Keratoconus Eye With Intrastromal Corneal Ring Segment Implantation. Eye Contact Lens 2016; 42:e12-6. [DOI: 10.1097/icl.0000000000000159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Feasibility of custom-made hydrogel contact lenses in keratoconus with previous implantation of intracorneal ring segments. Cont Lens Anterior Eye 2015; 38:351-6. [DOI: 10.1016/j.clae.2015.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 02/11/2015] [Accepted: 03/31/2015] [Indexed: 11/21/2022]
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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.
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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.
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Soft contact lens fitting after intrastromal corneal ring segment implantation to treat keratoconus. Cont Lens Anterior Eye 2014; 37:377-81. [DOI: 10.1016/j.clae.2014.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 06/01/2014] [Accepted: 06/04/2014] [Indexed: 11/24/2022]
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Klühspies U, Grunder A, Goebels S, Schirra F, Seitz B. [Keratoconus lenses: the small correction miracle]. Ophthalmologe 2014; 110:830-6, 838. [PMID: 23948734 DOI: 10.1007/s00347-013-2819-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Keratoconus is a non-inflammatory corneal disease associated with a cone-shaped protrusion and progressive corneal thinning. Apart from progression control and stabilizing interventions, correcting the optical error induced by a mostly highly irregular corneal surface is of paramount importance with respect to quality of life and ability to work. This goal can be achieved efficiently by contact lenses with only rare adverse conditions. This article provides a current overview on contact lens fitting in keratoconus and presents own associated results.
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Affiliation(s)
- U Klühspies
- Kontaktlinsenambulanz, Universitätsklinikum des Saarlandes UKS, Kirrbergerstr. 1, 66424, Homburg, Deutschland.
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Alfonso JF, Lisa C, Fernández-Vega L, Madrid-Costa D, Montés-Micó R. Intrastromal corneal ring segment implantation in 219 keratoconic eyes at different stages. Graefes Arch Clin Exp Ophthalmol 2011; 249:1705-12. [DOI: 10.1007/s00417-011-1759-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 05/19/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022] Open
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Alfonso JF, Lisa C, Fernández-Vega L, Madrid-Costa D, Poo-López A, Montés-Micó R. Intrastromal corneal ring segments and posterior chamber phakic intraocular lens implantation for keratoconus correction. J Cataract Refract Surg 2011; 37:706-13. [PMID: 21420596 DOI: 10.1016/j.jcrs.2010.10.060] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 10/27/2010] [Accepted: 10/29/2010] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate the efficacy, safety, and predictability of sequential implantation of Keraring intrastromal corneal ring segments (ICRS) and an Implantable Collamer Lens phakic intraocular lens (pIOL) with corneal relaxing incisions for refractive correction of keratoconus. SETTING Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN Cohort study. METHODS This study comprised patients with keratoconus who had ICRS implantation followed 6 months later by pIOL implantation with corneal relaxing incisions. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities and residual refractive errors, analyzed using vector analysis, were recorded preoperatively, 6 months after ICRS implantation, and 6 months after pIOL implantation. RESULTS The study enrolled 40 eyes (31 patients). The mean UDVA (decimal) was 0.11 Snellen ± 0.05 (SD) preoperatively, 0.18 ± 0.14 Snellen 6 months after ICRS implantation (P=.001), and 0.50 ± 0.27 Snellen 6 months after pIOL implantation (P<.0001). The mean CDVA was 0.56 ± 0.23 Snellen, 0.68 ± 0.25 Snellen, and 0.73 ± 0.20 Snellen, respectively (all P<.0001). Six months after pIOL implantation, the efficacy index was 0.88 and the safety index, 1.28. At 6 months, 65% of eyes were within ±1.00 diopter (D) of the desired refraction and 45% were within ±0.50 D. The mean spherical equivalent after pIOL implantation was -1.19 ± 1.33 D. CONCLUSION Sequential ICRS and pIOL implantation plus corneal relaxing incisions provided good visual and refractive outcomes, indicating that it is a predictable procedure for refractive correction of keratoconus. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- José F Alfonso
- Fernández-Vega Ophthalmological Institute, Surgery Department, School of Medicine, University of Oviedo, Oviedo, Spain.
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A Comparison of Synergeyes Versus Traditional Rigid Gas Permeable Lens Designs for Patients With Irregular Corneas. Eye Contact Lens 2008; 34:198-200. [DOI: 10.1097/icl.0b013e31815c859b] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE To describe a patient with keratoconus who underwent Intacs surgery to one eye with an unsatisfactory result and refused to undergo an Intacs removal procedure. METHODS Case report. RESULTS The patient's eye was fitted with a soft contact lens for visual rehabilitation 5 months after Intacs placement. CONCLUSIONS Intacs, with the help of secondary refractive procedures or contact lenses, may still be considered as effective in postponing penetrating keratoplasty, even in patients with advanced keratoconus.
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Affiliation(s)
- Omür O Uçakhan
- Department of Ophthalmology, Ankara University School of Medicine, Turkey.
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