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Vega A, Alió JL. Criteria for patient selection and indication for intracorneal ring segments in keratoconus. EYE AND VISION (LONDON, ENGLAND) 2024; 11:13. [PMID: 38528633 PMCID: PMC10964652 DOI: 10.1186/s40662-024-00379-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/23/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Keratoconus is an ectatic, progressive corneal disorder characterized by alterations in the morphology of the corneal tissue that leads to limitation of visual function of the patient. Intracorneal ring segments (ICRS) are small synthetic devices that are implanted in the corneal stromal in order to regularize the morphology of the tissue therefore improving the visual function and the quality of life of the patients. MAIN TEXT The present narrative review summarizes the main scientific articles developed by the authors in relation to the clinical outcomes and long-term results of ICRS in the treatment of keratoconus. It was found that those patients that benefit the most from this surgical intervention are those that have the most severe form of keratoconus. Additionally, patients with good visual function, those with more than 0.9 in the decimal scale are at risk of losing visual acuity after ICRS implantation. In relation to long-term results, scientific investigations published by the authors demonstrate that ICRS is a stable procedure after long period of time in terms of vision, refraction, and topographic variables in those patients with stable keratoconus. However, in patients with keratoconus and signs of progression, ICRS may not have the capability of halting the progression of the disease. Using artificial intelligence to guide ICRS implantation provide better clinical outcomes and improvement in corneal higher-order aberrations in patients with keratoconus in comparison to those treated using the commercial nomogram of implantation. CONCLUSIONS ICRS is a safe surgical procedure in the treatment of keratoconus. Patients that benefit most from the surgery are those with a significant visual impairment. ICRS should not be considered in patients with good visual function because of the risk of losing lines of vision. Long-term follow-up demonstrate stability of the clinical outcomes in patients with stable keratoconus although ICRS may not have the ability of halting the progression of the disease. New technologies based artificial intelligence improved the indications and the clinical outcomes of keratoconus patients treated with ICRS.
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Affiliation(s)
- Alfredo Vega
- Grupo Miranza, Alicante, Spain
- Universidad Miguel Hernandez de Elche, Alicante, Spain
- Hospital Virgen de los Lirios de Alcoy, Alicante, Spain
| | - Jorge L Alió
- Grupo Miranza, Alicante, Spain.
- Universidad Miguel Hernandez de Elche, Alicante, Spain.
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Al Bdour M, Abu-Ameerh M, Gharaibeh A, AlQudah R, Hubaishy L, AlAdwan M, AlRyalat SA. Intrastromal corneal ring segments for keratoconus patients: up to 12 years follow up. Int Ophthalmol 2024; 44:50. [PMID: 38336951 DOI: 10.1007/s10792-024-02912-5] [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: 03/01/2023] [Accepted: 12/24/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE Intrastromal corneal ring segment (ICRS) implantation is a surgical technique developed with the purpose of avoiding the progression of corneal protrusion and is considered a viable option for managing patients with keratoconus as it stabilizes or improves vision thus delaying or excluding the need of more advanced surgical intervention such as penetrating keratoplasty. However, long term follow up is still limited to determine its actual success in achieving this goal. The current project aims to provide an extended follow up reporting a mean followup of around 5 years, extending up to 12.5 years. METHODS We recruited patients who performed their ICRS between 2008 and 2013. We contacted patients for a follow up exam with a possible corneal tomography. For each patient, we obtained baseline pre operative data and latest follow up data which included visual acuity, subjective refraction, clinical slit-lamp exam, and corneal tomography. We compared the change in best corrected visual acuity and maximum keratometry readings from clinical visits before ring implantation to the latest follow up. RESULTS A total of 68 eyes for 53 patients were included. The mean duration of follow up was 53.87 (± 38.8) months, with a maximum duration of 153 months. We found a significant improvement in corrected and uncorrected visual acuity, keratometries and refraction during the follow up period. On correlation analysis, strong negative significant correlation was found between duration since surgery and change in uncorrected visual acuity (p = 0.03, ρ = 0.338) and mean keratometry values (p = 0.033, ρ = 0.296). At the latest follow up for majority of patients with more than 100 weeks of follow up (12 eyes), uncorrected visual acuity were equal to or worse than baseline. CONCLUSION This study represents the largest follow up for ICRS implanted in keratoconus patients. Improvement of visual acuity following ICRS implantation can be expected in the first few years, after which, a decline occurring thereafter.
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Affiliation(s)
- Muawyah Al Bdour
- Department of Ophthalmology, The University of Jordan, Amman, 11942, Jordan
| | | | - Almutez Gharaibeh
- Department of Ophthalmology, The University of Jordan, Amman, 11942, Jordan
| | - Ruba AlQudah
- Department of Ophthalmology, The University of Jordan, Amman, 11942, Jordan.
| | - Lana Hubaishy
- Department of Ophthalmology, The University of Jordan, Amman, 11942, Jordan
| | - Mai AlAdwan
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
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Khanthik A, Kasetsuwan N, Yaisawang S, Reinprayoon U, Puangsricharern V, Satitpitakul V. Factors predicting the visual outcome of intracorneal ring segment for keratoconus. PLoS One 2024; 19:e0288181. [PMID: 38319899 PMCID: PMC10846708 DOI: 10.1371/journal.pone.0288181] [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: 06/20/2023] [Accepted: 12/29/2023] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVES To identify predictive factors and to construct predictive models using epidemiological and clinical preoperative factors for the visual acuity change after intracorneal ring segment (ICRS) implantation in patients with keratoconus. METHODS The medical records of 287 keratoconic eyes of 230 patients implanted with ICRS at Chula Refractive Surgery Center of a tertiary university hospital (Bangkok, Thailand) between January 2012 and March 2022 were retrospectively reviewed for epidemiological and clinical preoperative variables, including those derived from Scheimpflug tomography. After randomly excluding one eye for each bilateral case, the remaining 230 eyes were randomized into two groups: a training group (184 eyes) and a validation group (46 eyes). In the training group, the correlation between the interesting variables and postoperative uncorrected and corrected distance visual acuity change (ΔUDVA and ΔCDVA; logMAR scale) at 6 months was explored, and then the multiple linear regression analysis was used to develop the predictive models. The obtained models were tested using the validation group. RESULTS There were 5 and 14 preoperative variables that statistically correlated with ΔUDVA and ΔCDVA respectively. Only the preoperative corrected distance visual acuity (CDVAp) strongly correlated with ΔCDVA (Beta = -0.746). Using multiple regression, the preoperative uncorrected distance visual acuity (UDVAp) and front mean keratometry were selected in the proposed model for ΔUDVA (adjusted R2 = 38.8%), while the CDVAp and index of surface variance (ISV) were selected in the model [Formula: see text] (adjusted R2 = 48.9%). The ΔUDVA and ΔCDVA models were correct in 47.83% and 63.4% of the validation group within 0.20 logMAR, respectively. CONCLUSIONS Potential predictive factors and models for ICRS-induced changes in visual acuity are proposed as adjunctive tools for clinicians. Such tools could be used for case selection and during counselling before ICRS implantation to maximize surgical outcomes.
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Affiliation(s)
- Apisit Khanthik
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | - Ngamjit Kasetsuwan
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital and Faculty of Medicine, Department of Ophthalmology, Excellence Center of Cornea and Limbal Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - Sasi Yaisawang
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
| | - Usanee Reinprayoon
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital and Faculty of Medicine, Department of Ophthalmology, Excellence Center of Cornea and Limbal Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - Vilavun Puangsricharern
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital and Faculty of Medicine, Department of Ophthalmology, Excellence Center of Cornea and Limbal Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
| | - Vannarut Satitpitakul
- Faculty of Medicine, Department of Ophthalmology, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital and Faculty of Medicine, Department of Ophthalmology, Excellence Center of Cornea and Limbal Stem Cell Transplantation, Chulalongkorn University, Bangkok, Thailand
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Soares JSB, Chaves LFOB, Torquetti L, Cunha PFDAD, Toledo M, Rocha G, Magacho L. Results of intrastromal corneal ring implantation in advanced keratoconus With the aim of postpoing or avoiding corneal transplantation. Eur J Ophthalmol 2024; 34:71-78. [PMID: 37700603 DOI: 10.1177/11206721231201661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of the surgery of intracorneal ring segment implantation with 320° of arc (320-ICRS) in patients with advanced keratoconus stage IV and maximum keratometry (Kmax) above 60 D. METHODS A prospective, interventional case series study evaluating 25 eyes of 19 patients with keratoconus stage IV and Kmax > 60D in which 320-ICRS were implanted using VisuMax® femtosecond. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometric values (mean - mean-K, flat - K1, and steep - K2), maximum keratometry (Kmax), tomographic astigmatism, refractive astigmatism and asphericity (Q) were assessed preoperatively and at 3, 6 and 12 months after the procedure. RESULTS The UDVA improved from 1.03 ± 0.28 LogMAR (20/200) to 0.54 ± 0.21 LogMAR (20/60), (p < 0.001), the CDVA (with glasses) improved from 0.63 ± 0.29 LogMAR (20/80) to 0.31 ± 0.16 LogMAR (20/40),(p = 0.004), K1 reduced from 54.41 ± 4.46 D to 49.36 ± 4.11 D (p < 0.001), K2 reduced from 61.15 ± 4.37 D to 53.715 ± 4.05 D, (p < 0.001), mean-K reduced from 57.55 ± 4,17 D to 51.44 ± 3,94 D (p < 0.001), Kmax reduced from 69.80 ± 8.20 D to 63.43 ± 6.31 D (p < 0.001) and asphericity (Q) changed from -1.57 ± 0.35 to -0.77 ± 0.56 (p < 0.001). A total of 89.9% patients reached BCVA wearing scleral contact lens 0.2 LogMAR(20/25). CONCLUSION 320-ICRS to treat advanced keratoconus appears to be an efficacious and safe procedure, being a surgical alternative to delay or even prevent corneal transplantation.
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Affiliation(s)
| | | | - Leonardo Torquetti
- Cornea Department, Center for Excellence in Ophthalmology, Pará de Minas, Brazil
| | | | - Marcia Toledo
- Cornea Department, Center for Reference in Ophthalmology, Federal University of Goiás,Goiânia (GO), Brazil
| | - Guilherme Rocha
- Cornea Department, Brasilia Ophthalmological Hospital; Av. L2 Sul SGAS 607 Módulo G, Brasilia 70.200-670, Brazil
| | - Leopoldo Magacho
- Cornea Department, Center for Reference in Ophthalmology, Federal University of Goiás,Goiânia (GO), Brazil
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M. van den Berg R, B. van den Berg A, Dodhia M, Shahid M, Jammal AA, de Freitas D, Rocha KM. Scheimpflug-Derived Corneal Lower and Higher Order Aberrations Post Intrastromal Corneal Ring Segments for Keratoconus. Vision (Basel) 2022; 6:vision6040076. [PMID: 36548938 PMCID: PMC9784986 DOI: 10.3390/vision6040076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/24/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Intrastromal corneal ring segments (ICRS) improve corneal topographic symmetry and reduce corneal aberrations through regularization of the corneal surface, thereby functioning as a viable surgical intervention for patients with keratoconus. This study aims to evaluate changes in lower- (LOAs) and higher-order aberrations (HOAs) amongst varying pupil sizes pre- and post- ICRS implantation in keratoconus patients. We specifically investigate the impact of pupil size on total corneal HOAs up to the 6th order. Twenty-one eyes that underwent ICRS implantation were included in this prospective interventional study. LOAs and HOAs measurements at the 6 mm, 4 mm, and 2 mm pupil diameters were collected preoperatively and at 6 months postoperatively using the Zernicke analysis function on a Scheimpflug device. ICRS implantation demonstrated a statistically significant effect in vertical coma with a −0.23 reduction (p = 0.015) for a 4 mm pupil size and a −1.384 reduction (p < 0.001) for 6 mm, with no significant effect at 2 mm. Horizontal coma, astigmatism 0°, astigmatism 45°, trefoil 5th order 30°, and RMS HOA demonstrated significant reductions at 4 mm or 6 mm pupil sizes but not at 2 mm. Our analysis demonstrates a favorable effect of ICRS implantation on larger pupil sizes, suggesting the importance of pupil size as it correlates with HOAs reduction.
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Affiliation(s)
- Roberta M. van den Berg
- Storm Eye Institute, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA
- Ophthalmology Department, Federal University of Sao Paulo (UNIFESP), São Paulo 04023-062, Brazil
- Correspondence:
| | - Arthur B. van den Berg
- Storm Eye Institute, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA
- Ophthalmology Department, Federal University of Sao Paulo (UNIFESP), São Paulo 04023-062, Brazil
| | - Maya Dodhia
- Storm Eye Institute, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA
| | - Michel Shahid
- School of Medicine Columbia, University of South Carolina, Columbia, SC 29208, USA
| | | | - Denise de Freitas
- Ophthalmology Department, Federal University of Sao Paulo (UNIFESP), São Paulo 04023-062, Brazil
| | - Karolinne M. Rocha
- Storm Eye Institute, Medical University of South Carolina (MUSC), Charleston, SC 29425, USA
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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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Anders P, Anders LM, Elalfy M, Hamada S, Seitz B, Gatzioufas Z. Effect of intracorneal ring segment implantation on high order aberrations comparing patients with eccentric versus central keratoconus. Eur J Ophthalmol 2021; 32:36-42. [PMID: 34405714 DOI: 10.1177/11206721211041022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess potential differences between central and eccentric cones in the aberrometric corneal profile and in visual and keratometric outcomes 6 months after intracorneal ring segment (ICRS) implantation for keratoconus. METHODS This study compared two groups consisting of 12 patients each, with central or eccentric keratoconus who were treated with femtosecond laser-assisted Keraring implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, keratometric readings and higher order aberrations (HOAs) including high order aberrations root mean square (HOARMS), coma, spherical aberration and trefoil were measured preoperatively and 6 months after ICRS implantation. RESULTS Trefoil and spherical aberration were significantly reduced after ICRS implantation compared to preoperative values in eccentric keratoconus (Trefoil, p = 0.0049; Spherical aberration, p < 0.0001). In central keratoconus spherical aberration was reduced not significantly after ICRS implantation compared to preoperative values (p = 0.087). Coma showed a significant reduction in central (p = 0.0001) and in eccentric keratoconus (p = 0.0001). The reduction of spherical aberration in central keratoconus was significantly positively correlated to improvement in UDVA (Pearson's correlation coefficient, r = -0.66; p = 0.02). In eccentric keratoconus there was a significant positive correlation between reduction of trefoil and improvement in UDVA (Spearmans R, r = -0.69; p = 0.01). CONCLUSION Patients both with central and eccentric keratoconus benefit from ICRS implantation. Specifically, our data provide a slightly higher gain in visual performance for eccentric cones 6 month after ICRS implantation, which is accentuated by a greater reduction in spherical aberration and trefoil. Improvements in UDVA are positively correlated with reductions in HOAs.
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Affiliation(s)
- Philipp Anders
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Lisa-Marie Anders
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
| | - Mohamed Elalfy
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, UK
| | - Samer Hamada
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, West Sussex, UK
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Zisis Gatzioufas
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
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Jadidi K, Naderi M, Mosavi SA, Nejat F, Aghamolaei H, Serahati S. Pre‐operative factors influencing post‐operative outcomes from MyoRing implantation in keratoconus. Clin Exp Optom 2021; 102:394-398. [DOI: 10.1111/cxo.12859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/21/2018] [Accepted: 11/03/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Khosrow Jadidi
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran,
| | - Mostafa Naderi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran,
| | | | - Farhad Nejat
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran,
| | - Hosein Aghamolaei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran,
| | - Sara Serahati
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran,
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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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Tahvildari M, Singh RB, Saeed HN. Application of Artificial Intelligence in the Diagnosis and Management of Corneal Diseases. Semin Ophthalmol 2021; 36:641-648. [PMID: 33689543 DOI: 10.1080/08820538.2021.1893763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Diagnosis and treatment planning in ophthalmology heavily depend on clinical examination and advanced imaging modalities, which can be time-consuming and carry the risk of human error. Artificial intelligence (AI) and deep learning (DL) are being used in different fields of ophthalmology and in particular, when running diagnostics and predicting outcomes of anterior segment surgeries. This review will evaluate the recent developments in AI for diagnostics, surgical interventions, and prognosis of corneal diseases. It also provides a brief overview of the newer AI dependent modalities in corneal diseases.
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Affiliation(s)
- Maryam Tahvildari
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hajirah N Saeed
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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11
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Naderi M, Karimi F, Jadidi K, Mosavi SA, Ghobadi M, Tireh H, Khorrami-Nejad M. Long-term results of MyoRing implantation in patients with keratoconus. Clin Exp Optom 2021; 104:499-504. [PMID: 33689613 DOI: 10.1080/08164622.2021.1878813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Clinical relevance: This study was conducted to evaluate five-year outcomes of MyoRing implantation in patients with keratoconus. The results showed that MyoRing implantation is a minimally invasive procedure and is safe and effective for improving visual acuity and refraction in most patients with keratoconus.Background: The long-term effects of MyoRing implantation on corneal features were studied.Methods: A total of 48 keratoconic eyes of 43 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, gmbh, Linz, Austria) and who had completed five years of follow‑ups were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and assessed pre-operation, and five years post-operatively. As well, post-operation satisfaction was assessed using a validated questionnaire.Results: Five years post-operatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (p < 0.001). Mean UDVA was 1.20 logMAR before the surgery and 0.42 after the surgery (p < 0.001). Mean CDVA was 0.63 logMAR before the surgery and 0.20 logMAR after the surgery (p < 0.001). SE was improved from -6.53 dioptres (D) before the surgery to -2.23 D after the surgery (p < 0.001). Moreover, the results show that the mean K was reduced by 2.82 D after the surgery (p = 0.001). Overall, 81% of patients were moderately to highly satisfied five years after surgery.Conclusion: MyoRing implantation was found to be a minimally invasive procedure, and is safe and effective for improving visual acuity and refraction in most patients with keratoconus.
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Affiliation(s)
- Mostafa Naderi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | - Farshid Karimi
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khosrow Jadidi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | | | - Mohadeseh Ghobadi
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Tireh
- Department of Epidemiology and Biostatistics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Shetty R, Israni NA, Ramuka S, Dadachanji Z, Roy AS, Mehra R, Lalgudi VG. Intracorneal Ring Segments Followed by Simultaneous Topography-Guided Removal of Epithelium and Stroma With Accelerated Collagen Cross-Linking For Keratoconus (I-TRESK/CXL). Asia Pac J Ophthalmol (Phila) 2020; 10:152-160. [PMID: 33369925 DOI: 10.1097/apo.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to assess the visual, topographic, and aberrometric outcomes of a novel tissue sparing technique, topography-guided removal of epithelium, and stroma in keratoconus (TRESK) along with accelerated collagen cross-linking (CXL), 1 month after Intacs insertion. DESIGN Prospective interventional study. METHODS Fourty-eight eyes (45 patients) with keratoconus underwent femto-assisted Intacs insertion. After 1 month, TRESK and CXL (9 mW/cm2 for 10 minutes) was done. TRESK is a decentered trans-PTK (phototherapeutic keratectomy) with center and area of ablation at the location of the steepest tangential anterior curvature and area of the cone respectively. Total ablation (epithelium plus stroma) was limited to 75 μm. Postoperative measurements were performed 1 month after Intacs, 6 weeks after Intacs followed by TRESK/CXL, and at the final visit 12 months after Intacs followed by TRESK/CXL. RESULTS For all eyes studied, uncorrected distance visual acuity and corrected distance visual acuity (CDVA) (logMAR) improved from preoperative means of 1.05 ± 0.05 and 0.31 ± 0.03 logMAR to postoperative means of 0.52 ± 0.05 (P < 0.001) and 0.20 ± 0.02 logMAR (P = 0.009), respectively. The mean preoperative sphere, cylinder and mean refractive spherical equivalent decreased from -4.52 ± 0.98 D, -4.81 ± 0.25 D, -6.93 ± 0.99 D to -0.77 ± 0.53 D (P = 0.029), -3.13 ± 0.24 D (P = 0.002), and -2.34 ± 0.53 D (P = 0.021), respectively with a mean keratometric flattening of 5.06D (P < .0001) at the final visit. In total, 2.08% of the eyes lost 1 Snellen line of CDVA. Sixty eight percent and 27% of the eyes gained 2 Snellen lines or more of uncorrected distance visual acuity and CDVA, respectively. CONCLUSIONS Simultaneous TRESK with CXL done 1 month after Intacs insertion (I-TRESK) in keratoconus eyes provided significant visual gain with refractive and topographic improvement. This novel procedure involving customized PTK before CXL is safe, easy to plan and perform, and provides good outcomes.
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Affiliation(s)
- Rohit Shetty
- Department of Cornea and Refractive surgery, Narayana Nethralaya, Bangalore, India
| | - Neeraj Ashok Israni
- Department of Cornea and Refractive surgery, Narayana Nethralaya, Bangalore, India
| | - Saurabh Ramuka
- Department of Cornea and Refractive surgery, Narayana Nethralaya, Bangalore, India
| | - Zelda Dadachanji
- Department of Cornea and Refractive surgery, Narayana Nethralaya, Bangalore, India
| | - Abhijit Sinha Roy
- Imaging, Biomechanics and mathematical modelling solutions lab, Narayana Nethralaya foundation, Bangalore, India
| | - Rohan Mehra
- Department of Cornea and Refractive surgery, Narayana Nethralaya, Bangalore, India
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Ting DSJ, Foo VH, Yang LWY, Sia JT, Ang M, Lin H, Chodosh J, Mehta JS, Ting DSW. Artificial intelligence for anterior segment diseases: Emerging applications in ophthalmology. Br J Ophthalmol 2020; 105:158-168. [PMID: 32532762 DOI: 10.1136/bjophthalmol-2019-315651] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/21/2020] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
With the advancement of computational power, refinement of learning algorithms and architectures, and availability of big data, artificial intelligence (AI) technology, particularly with machine learning and deep learning, is paving the way for 'intelligent' healthcare systems. AI-related research in ophthalmology previously focused on the screening and diagnosis of posterior segment diseases, particularly diabetic retinopathy, age-related macular degeneration and glaucoma. There is now emerging evidence demonstrating the application of AI to the diagnosis and management of a variety of anterior segment conditions. In this review, we provide an overview of AI applications to the anterior segment addressing keratoconus, infectious keratitis, refractive surgery, corneal transplant, adult and paediatric cataracts, angle-closure glaucoma and iris tumour, and highlight important clinical considerations for adoption of AI technologies, potential integration with telemedicine and future directions.
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Affiliation(s)
- Darren Shu Jeng Ting
- Academic Ophthalmology, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham, UK.,Singapore Eye Research Institute, Singapore
| | | | | | - Josh Tjunrong Sia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore.,Cornea And Ext Disease, Singapore National Eye Centre, Singapore
| | - Haotian Lin
- Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - James Chodosh
- Ophthalmology, Massachusetts Eye and Ear Infirmary Howe Laboratory Harvard Medical School, Boston, Massachusetts, USA
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore.,Cornea And Ext Disease, Singapore National Eye Centre, Singapore
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore .,Vitreo-retinal Department, Singapore National Eye Center, Singapore
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Femtosecond Laser Implantation of a 355-Degree Intrastromal Corneal Ring Segment in Keratoconus: A Three-Year Follow-Up. J Ophthalmol 2019; 2019:6783181. [PMID: 31687200 PMCID: PMC6803737 DOI: 10.1155/2019/6783181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the outcomes of femtosecond laser-assisted implantation of a 355-degree intracorneal ring (ICR) (Keraring) in patients with keratoconus in the three-year follow-up. Setting Future Femtolaser Center, Sohag, Egypt. Design Prospective interventional case series. Patients and Methods A prospective case series of 38 eyes of 26 patients with keratoconus had implantation of the 355-degree ICR keraring after tunnel creation with a femtosecond laser. The uncorrected visual acuities (UCVA) and best-corrected visual acuities (BCVA), sphere, cylinder, and manifest refraction spherical equivalent (SE), and mean keratometry (K), K max, and K min were evaluated preoperatively and 3, 6, 12, 24, and 36 months postoperatively, and all complications were reported. Results 38 eyes of 26 patients with mean age 25.92 ± 5.44 years were enrolled in the study, 11 were males (42.3%). The mean UCVA improved from 0.93 ± 0.21 to 0.63 ± 0.21 logMAR (P ≤ 0.001) and the mean BCVA from 0.67 ± 0.22 to 0.43 ± 0.26 logMAR (P < 0.001). The mean sphere, cylinder, and spherical equivalent have been changed dramatically from preoperative to 3 month postoperative, which is statistically significant (P ≤ 0.001), and the changes between 1 and 2 years and 2 and 3 years are also considerable and statistically significant; the K max and K min and K mean improved and the changes were statistically significant (P ≤ 0.001), and the changes between one, two, and three years were also statistically significant. The safety and efficacy indices were changed through the three-year follow-up. The complications were corneal neovascularization (36.84%), corneal melting (26.3%), and ring extrusion (31.5%) at the end of the study. Conclusions Implantation of a 355-degree intracorneal keraring using femtosecond laser improved the visual, refractive, and topographic parameters in keratoconus patients, with a high rate of ICR extrusion and instability. The study has been registered for the Pan African Clinical Trial Registry (http://www.pactr.org) database within No: PACTR201810796878908 on 29 October 2018.
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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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Nagaraj R, Bijukumar DR, Mathew B, Scott EA, Mathew MT. A review on recent advancements in ophthalmology devices: Currently in market and under clinical trials. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.04.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Kumar M, Shetty R, Dutta D, Rao HL, Jayadev C, Atchison DA. Effects of a semi-scleral contact lens on refraction and higher order aberrations. Cont Lens Anterior Eye 2019; 42:670-674. [PMID: 31230973 DOI: 10.1016/j.clae.2019.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/23/2019] [Accepted: 06/11/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate effects of Rose K2 XL semi-scleral contact lenses (Menicon Co.) on visual acuity and higher-order aberrations in eyes with irregular corneas. METHODS One hundred and twelve eyes of 84 patients fitted with Rose K2 XL lenses were analysed. Participants were in 4 clinical groups: keratoconus, intra-corneal ring segments, radial keratotomy, and penetrating keratoplasty. Corrected distance visual acuity and ocular aberrations were determined before lens wear and 60 min into lens wear. The i-Trace aberrometer was used to determine aberrations at 4.5 mm pupil size. RESULTS There were 55, 22, 19 and 16 eyes in keratoconus, intra-corneal ring segments, radial keratotomy and penetrating keratoplasty groups, respectively. Before lens wear, eyes had poor corrected distance vision acuity (mean and standard deviation +0.55 ± 0.33 logMAR), high negative spherical equivalent refraction (-6.4 ± 3.7 D), high cylindrical errors (4.5 ± 2.2 D), large higher-order root-mean-squared (HO-RMS) aberration (1.5 ± 1.3 μm) and large higher-order aberration components. Cylinder was particular high for the penetrating keratoplasty group (mean 5.9 ± 2.5 D), root-mean-squared third-order coma was lowest for the radial keratotomy group (0.7 ± 1.0 μm), and fourth-order spherical aberration was highly negative for the intra-corneal ring segment group (co-efficient -0.4 ± 0.7 μm). With lens wear, the values changed considerably. Corrected distance visual acuity improved by 0.51 ± 0.31 logMAR, cylinder decreased by 3.6 ± 2.1 D, HO-RMS aberration reduced by 1.1 ± 1.2 μm, and higher-order aberration components decreased considerably. Magnitudes of group changes reflected the magnitudes before lens wear. CONCLUSIONS Rose K2 XL semi-scleral contact lenses were effective in improving vision and reducing ocular aberrations for eyes with irregular corneas.
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Affiliation(s)
- Mukesh Kumar
- Cornea and Refractive Department, Narayana Nethralaya, Bangalore, India.
| | - Rohit Shetty
- Cornea and Refractive Department, Narayana Nethralaya, Bangalore, India
| | - Debarun Dutta
- School of Optometry and Vision Science, The University of New Wales, Sydney, New South Wales, Australia
| | - Harsha L Rao
- Cornea and Refractive Department, Narayana Nethralaya, Bangalore, India
| | - Chaitra Jayadev
- Cornea and Refractive Department, Narayana Nethralaya, Bangalore, India
| | - David A Atchison
- Institute of Health & Biomedical Innovation and School of Optometry & Vision Science, Queensland University of Technology, Kelvin Grove Q 4059 Australia
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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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19
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Sedaghat MR, Momeni-Moghaddam H, Piñero DP, Akbarzadeh R, Moshirfar M, Bamdad S, Gazanchian M. Predictors of Successful Outcome following Intrastromal Corneal Ring Segments Implantation. Curr Eye Res 2019; 44:707-715. [PMID: 30868919 DOI: 10.1080/02713683.2019.1594945] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose: To assess the preoperative visual, refractive, corneal topo/tomographic, aberrometric and biomechanical parameters as predictive factors of a successful outcome 6 months following intrastromal corneal ring segments implantation. Methods: Sixty-eight keratoconus eyes implanted with Keraring using femtosecond laser technology were assessed. The preoperative assessed parameters included uncorrected and corrected distance visual acuity (UDVA & CDVA), refraction, placido-disk based topography using TMS-4, Scheimplfug tomography using Pentacam HR, corneal biomechanical assessments using Ocular Response Analyzer (ORA) and the wavefront analysis using i-Trace aberrometer. Other variables were type of astigmatism based on orientation of the steep meridian, keratoconus staging based on the Amsler-Krumeich classification and the difference between the axes of refractive astigmatism, topographic astigmatism and comatic aberration based on a difference less or more than 30°. The success criterion was defined based on CDVA, a post-operative CDVA improvement at least two lines were considered as a success and otherwise were recognized as a failure following Keraring implantation. Results: Only UDVA, coincidence of the most elevated points on the front and back corneal surfaces and the difference between UDVA and CDVA showed significant difference between the eyes with successful outcomes and those with unsuccessful results (P < 0.05). Although corneal curvature and astigmatism were higher and corneal thickness was lower in the unsuccessful group, differences were not statistically significant. Conclusion: It is expected that the greater difference between the preoperative uncorrected and corrected distance visual acuity (Δ UDVA-CDVA) and more coincidence of the most elevated points in the two corneal surfaces on the elevation maps increase the rate of successful outcome following the Keraring implantation. Abbreviations: ICRS: intrastromal corneal ring segments; UDVA: uncorrected distance visual acuity; CDVA: corrected distance visual acuity; logMAR: logarithm of minimum angle of resolution; SE: spherical equivalent; IOP: intra-ocular pressure; Km: mean keratometry; CA: corneal astigmatism; WTR: with-the-rule; ATR: against-the-rule; OBL: oblique; SB: symmetric bow-tie; AB: asymmetric bow-tie; IS: inferior steepening; SRAX: skewed radial axis; Q: asphericity (Q-value); CCT: central corneal thickness; CTP: corneal thinnest point; ORA: ocular response analyzer; CH: corneal hysteresis; CRF: corneal resistance factor; HOAs: higher-orders aberrations; RMS: root mean square; SD: standard deviation; CI: confidence interval.
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Affiliation(s)
| | - Hamed Momeni-Moghaddam
- b Health Promotion Research Center , Zahedan University of Medical Sciences , Zahedan , Iran.,c Department of Optometry, School of Paramedical Sciences , Mashhad University of Medical Sciences , Mashhad , Iran
| | - David P Piñero
- d Department of Optics, Pharmacology and Anatomy , University of Alicante , Alicante , Spain
| | - Reyhaneh Akbarzadeh
- c Department of Optometry, School of Paramedical Sciences , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Majid Moshirfar
- e John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, School of Medicine , University of Utah , Salt Lake City , UT , USA.,f Utah Lions Eye Bank, University of Utah Health , Murray , UT , USA.,g HDR Research Center, Hoopes Vision , Draper , UT , USA
| | - Shahram Bamdad
- h Poostchi Ophthalmology Research Center , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Mehrdad Gazanchian
- a Eye Research Center , Mashhad University of Medical Sciences , Mashhad , Iran
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Rafati S, Hashemi H, Nabovati P, Doostdar A, Yekta A, Aghamirsalim M, Khabazkhoob M. Demographic profile, clinical, and topographic characteristics of keratoconus patients attending at a tertiary eye center. J Curr Ophthalmol 2019; 31:268-274. [PMID: 31528760 PMCID: PMC6742613 DOI: 10.1016/j.joco.2019.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose To evaluate the demographic profile, clinical, and topographic characteristics of keratoconus (KCN) patients attending at a subspecialty eye hospital in Tehran, Iran. Methods In this cross-sectional study, all patients who attended Noor Eye Hospital between March 2011 and March 2017 and had a diagnosis of KCN were identified, and the required number of patients was randomly selected. The following data were extracted from patient's records: age, sex, visual acuity, refraction, keratometry, pachymetry, and treatment procedures. The data of KCN laterality, severity, morphology, and cone location were also extracted by analyzing the corneal imaging maps. Results The records of 1080 eyes of 540 patients were evaluated. The mean age of the participants was 31.04 ± 8.54 years (range, 13–63 years), and 69.3% of the patients were male. The highest and lowest frequency of KCN was seen in the age group 20–30 years and above 50 years, respectively. Bilateral KCN was detected in 93.3% [95% confidence interval (CI): 91.68–94.75] of the subjects. 43.7% (95%CI: 32.88–54.48), 55.6% (95%CI: 44.73–66.38), and 0.8% (95%CI: 0.75–0.78) of the cases had nipple, oval, and globus cones, respectively. The cone was central in 52.1% (95%CI: 41.10–63.11), paracentral in 43.6% (95%CI: 36.13–51.04), and peripheral in 4.3% (95%CI: 00.76–7.86) of the cases. The frequency percentage of KCN according to severity was 15.2% (95%CI: 13.09–17.46), 56.4% (95%CI: 53.37–59.37), and 28.4% (95%CI: 25.75–31.21) for mild, moderate, and severe KCN, respectively. Among different parameters, only cone location had a significant association with age as the frequency of paracentral and peripheral cones increased with ageing (P = 0.002). Conclusions The mean age of KCN patients in our study was higher than similar studies in other Asian countries. KCN was bilateral in most cases with an oval morphology and central cone location. Most of the patients had moderate to severe KCN.
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Affiliation(s)
- Shokoofeh Rafati
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Asgar Doostdar
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbasali Yekta
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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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22
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Long-term outcome of intrastromal corneal ring segments in keratoconus: Five-year follow up. Sci Rep 2019; 9:315. [PMID: 30670787 PMCID: PMC6342932 DOI: 10.1038/s41598-018-36668-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/23/2018] [Indexed: 11/08/2022] Open
Abstract
To evaluate the effectiveness of intrastromal corneal ring segment (ICRS) use in keratoconus after five years. ICRS has been widely used to correct astigmatism and improve visual acuity in keratoconus. Although the short-term outcome is well known to be effective, long-term outcome has rarely been reported. A retrospective chart review was done. A total of 30 eyes diagnosed with keratoconus and treated with INTACS (Addition Technology, Sunnyvale, CA, USA) were included. Visual acuity, refraction, indices of corneal irregularity, and higher-order aberration were evaluated at preoperative, two months, one year, three years, and five years postoperatively. Uncorrected distance visual acuity (UDVA) and spherical and spherical equivalent were improved (p < 0.05) for three years. However, they worsened (p < 0.05) at five years to preoperative values. On the other hand, corrected distance visual acuity (CDVA) was improved for five years (p < 0.05). Topographic keratometry was flattened, and corneal irregularity indices were improved at five years (all p < 0.05). Coma RMS was improved (p < 0.05) continuously for five years. ICRS has advantages in improving CDVA with topographic stabilization and decreasing coma in keratoconus for five years.
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Mukhtar S, Ambati BK. Pediatric keratoconus: a review of the literature. Int Ophthalmol 2018; 38:2257-2266. [PMID: 28852910 PMCID: PMC5856649 DOI: 10.1007/s10792-017-0699-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the epidemiology and prevalence, rates of progression, difference between adult and pediatric populations, and therapeutic approaches to pediatric keratoconus from documented literature. METHODS A literature search was done on PubMed using key words including pediatric keratoconus, children with keratoconus, adult keratoconus, penetrating keratoplasty, corneal cross-linking and intracorneal ring segments. The literature was reviewed and reported to explore the key epidemiological differences between the pediatric and adult population with regards to presentation and treatment options. RESULTS Pediatric keratoconus is more aggressive than adult keratoconus, which has been explained by structural differences in the cornea between both populations. High rates of progression were documented in pediatric populations. While corneal collagen cross-linking, intracorneal ring segments and penetrating keratoplasties have been used as therapies in the pediatric population, the literature overwhelmingly shows higher rates of failure and progression despite these measures as compared to adults. CONCLUSION Pediatric keratoconus is more aggressive than adult keratoconus, and current therapies used in adults may not be sufficient for the pediatric population.
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Affiliation(s)
- Sabrina Mukhtar
- School of Medicine, Virginia Commonwealth University, 1201 E. Marshall St., 4th Floor, Richmond, VA, 232983, USA.
| | - Balamurali K Ambati
- Moran Eye Center, University of Utah, 64 Mario Capecchi Dr, Salt Lake City, UT, 84132, USA
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Alzahrani K, Cristian C, Harper S, Carley F, Brahma A, Morley D, Hillarby MC. Corneal imaging and densitometry measurements in keratoconus patients to monitor disease progression and treatment outcomes after contact lens or Intacs treatment. Clin Ophthalmol 2018; 12:1653-1658. [PMID: 30233127 PMCID: PMC6130308 DOI: 10.2147/opth.s168865] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim The aim of this study was to compare the pre- and posttreatment corneal densitometry and corneal thickness value of keratoconus (KCN) patients managed via contact lenses (CLs) or by both intrastromal corneal rings and contact lenses. Patients and methods This prospective study was performed at the Manchester Royal Eye Hospital, UK. Patients were recruited before treatment and followed up for 12 months. Data of corneal densitometry and corneal thickness were collected using the Oculus Pentacam at the pretreatment visit and posttreatment visit at 12 months. Results Corneal clarity significantly differs between both groups at pre treatment at zone 0-2 mm for the anterior layer (P=0.002). The same diversity is present at zone 2-6 mm for the anterior layer (P=0.003) and posterior layer (P=0.008). The corneal clarity diversity found was not statistically significant at 12 months post treatment (P>0.05). Corneal thickness was found to be statistically significantly different between pre treatment and post treatment for the CL group for central corneal thickness (CCT) and thinnest area (P=0.01 and P=0.02), respectively. Discussion This study shows that KCN management with Intacs was found to be effective in maintaining corneal clarity for a longer time than that with CL alone. On the other hand, corneal clarity reduces with disease progression in cases managed with CLs only. Analysis of Oculus Pentacam images provides an objective evaluation to monitor the corneal status after these different pathways of management.
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Affiliation(s)
- Khaled Alzahrani
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK, .,Ophthalmology Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia,
| | | | | | | | - Arun Brahma
- Manchester Royal Eye Hospital, Manchester, UK
| | | | - M Chantal Hillarby
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK,
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Gatzioufas Z, Panos GD, Elalfy M, Khine A, Hamada S, Lake D, Kozeis N, Balidis M. Effect of Conus Eccentricity on Visual Outcomes After Intracorneal Ring Segments Implantation in Keratoconus. J Refract Surg 2018. [PMID: 29522230 DOI: 10.3928/1081597x-20180115-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the potential impact of cone eccentricity on visual outcomes after Keraring (Mediphacos, Belo Horizonte, Brazil) implantation for keratoconus. METHODS Nineteen eyes from 19 patients with keratoconus who underwent femtosecond laser-assisted Keraring implantation for keratoconus were included in this retrospective study. Uncorrected visual acuity (UDVA), corrected visual acuity (CDVA), keratometric readings, central corneal thickness, maximum keratometric distance from corneal apex (DKmax), corneal thinnest point from corneal apex (DTh), and coma were evaluated preoperatively and 6 months after the Keraring implantation. DKmax and DTh were used as metrics reflecting the eccentricity of the cone. RESULTS UDVA, CDVA, keratometric readings, and coma improved at 6 months postoperatively. However, there was no correlation between DKmax or DTh and visual outcomes at 6 months postoperatively. CONCLUSIONS The data did not show any impact of the cone eccentricity on visual outcomes after Keraring implantation for keratoconus at 6 months postoperatively. [J Refract Surg. 2018;34(3):196-200.].
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Abou Samra WA, Badawi AE, Kishk H, Abd El ghafar A, Elwan MM, Abouelkheir HY. Fitting Tips and Visual Rehabilitation of Irregular Cornea with a New Design of Corneoscleral Contact Lens: Objective and Subjective Evaluation. J Ophthalmol 2018; 2018:3923170. [PMID: 29484205 PMCID: PMC5816849 DOI: 10.1155/2018/3923170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 12/07/2017] [Accepted: 12/17/2017] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To study the fitting and the visual rehabilitation obtained with a corneoscleral contact lens, namely, Rose K2 XL in patients with irregular cornea. METHODS This prospective study included 36 eyes of 36 patients with irregular cornea fitted with Rose K2 XL. Refractive and visual outcomes and mesopic and aberrometric parameters of fitted eyes were assessed at 2 weeks, 3 months, and 6 months after the initial lens use. Objective and subjective parameters of patient satisfaction and lens comfort were noted. Causes of lens discontinuation and complications were also recorded. RESULTS Average logMAR VA improved significantly from 0.95 ± 0.09 without correction to 0.04 ± 0.05 six months after lens wear. Similarly, mesopic and aberrometric measures were significantly improved. Statistical analysis of the subjective patients' responses showed a significant acceptance of the lens by most of them. At the end of follow-up, the mean wearing time was 9.9 ± 2.9 hours per day. The most common cause of wearing discontinuation was persistent discomfort (16.7%) and high lens expenses(16.7%). Self-assessed questionnaire showed statistically significant improvement in nearly all measured subjective parameters. CONCLUSION Rose K2 XL lenses provide patients with irregular cornea with both quantitative and qualitative optimal visual function with high degree of patient comfort and satisfaction.
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Affiliation(s)
| | - Amani E. Badawi
- Mansoura Ophthalmology Center, Mansoura University, Mansoura, Egypt
| | - Hanem Kishk
- Mansoura Ophthalmology Center, Mansoura University, Mansoura, Egypt
| | | | - Mohamed M. Elwan
- Mansoura Ophthalmology Center, Mansoura University, Mansoura, Egypt
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Gatzioufas Z, Khine A, Elalfy M, Guber I, McLintock C, Sabatino F, Hamada S, Lake D. Clinical Outcomes after Keraring Implantation for Keratoconus Management in Patients Older Than 40 Years: A Retrospective, Interventional, Cohort Study. Ophthalmol Ther 2017; 7:95-100. [PMID: 29275457 PMCID: PMC5997600 DOI: 10.1007/s40123-017-0117-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background Intracorneal ring segment implantation is an effective and safe method of visual improvement in patients with keratoconus. The aim of our study was to evaluate the long-term clinical outcomes after Keraring implantation for keratoconus in patients older than 40 years. Methods Eleven eyes from 11 patients with keratoconus who underwent femtosecond laser-assisted Keraring implantation for keratoconus were included in this retrospective study. The uncorrected visual acuity (UCVA), corrected visual acuity, keratometric readings, central corneal thickness and thinnest corneal pachymetry were evaluated preoperatively and 6 months after the Keraring implantation. Results UCVA, BCVA and keratometric readings improved at 6 months postoperatively. Conclusion Our data showed significant keratometric amelioration and visual improvement after Keraring implantation for keratoconus in patients older than 40 years at 6 months postoperatively.
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Affiliation(s)
- Zisis Gatzioufas
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.
| | - Aye Khine
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Mohamed Elalfy
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
- The Research Institute of Ophthalmology, Cairo, Egypt
| | - Ivo Guber
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | | | | | - Samer Hamada
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Damian Lake
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Mohammadpour M, Heidari Z, Hashemi H. Updates on Managements for Keratoconus. J Curr Ophthalmol 2017; 30:110-124. [PMID: 29988906 PMCID: PMC6034171 DOI: 10.1016/j.joco.2017.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 10/07/2017] [Accepted: 11/05/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose Keratoconus is a progressive disease of the cornea which can lead to blindness as irregular astigmatism increases. Currently, a variety of methods are available for the treatment of keratoconus, and in certain cases, it may be difficult to choose the most appropriate option. This article reviews available treatment modalities for keratoconus to provide the practitioner with practical and useful information for selecting the most suitable option for each individual patient. Methods To review treatment methods for different stages of keratoconus, PubMed (United States National Library of Medicine) and Scopus (Elsevier BV) databases were searched using the keywords “keratoconus”, “contact lens”, “cross-linking”, “Intacs”, “keratoplasty”, “gene therapy”, and “irregular astigmatism”, and related articles were reviewed based on disease assessment parameters and treatment methods. Results Various methods are available for the treatment of keratoconus: eyeglasses and contact lenses in the early stages, cross-linking for stabilizing disease progression, intrastromal corneal ring segments (ICRS) for reducing refractive errors or flattening the cornea, and penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK), conductive keratoplasty, gene therapy and more recently, bowman layer transplantation (BL transplantation) in advanced stages of the disease. To achieve optimum results, it is essential to choose the best option for each individual patient. Conclusions A commonality of the reviewed papers was the advancement of novel diagnostic and treatment methods in ophthalmology, which can delay the need for corneal grafting. A better understanding of keratoconus treatment options can help enhance visual rehabilitation and prevent blindness in keratoconus patients.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Ophthalmology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Zahra Heidari
- Eye Research Center, Ophthalmology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
- Corresponding author. No. 96 Esfandiar Blvd., Vali'asr Ave., Tehran, Iran.
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
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Corneal Hydrops Secondary to Intrastromal Corneal Ring Intrusion into the Anterior Chamber 7 Years after Implantation: A Case Report. Ophthalmol Ther 2017; 6:373-379. [PMID: 28849554 PMCID: PMC5693822 DOI: 10.1007/s40123-017-0105-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION This report describes the first known case of late-onset intrusion of an intrastromal ring segment into the anterior chamber due to posterior migration of a ring segment. To our knowledge, intrastromal ring segment penetration has only been shown to occur in the intraoperative or immediate postoperative period. We postulate that the perforation in this case is due to progressive thinning of the cornea, possibly in combination with habitual eye rubbing. CASE REPORT A 44-year-old man presented with acute corneal hydrops related to penetration of Descemet's membrane and endothelium by an intrastromal ring segment implanted 7 years prior. Removal of the ring segment resulted in an anterior chamber fistula that directed fluid through the ring segment tunnel to the ocular surface. Leakage of aqueous humor was successfully controlled, and corneal edema gradually resolved. CONCLUSION This case indicates the need for long term monitoring of ring segment proximity to the posterior corneal surface, especially in patients with ectatic ocular conditions and/or habitual eye rubbing behavior.
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Andreanos KD, Hashemi K, Petrelli M, Droutsas K, Georgalas I, Kymionis GD. Keratoconus Treatment Algorithm. Ophthalmol Ther 2017; 6:245-262. [PMID: 28755306 PMCID: PMC5693837 DOI: 10.1007/s40123-017-0099-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Indexed: 11/25/2022] Open
Abstract
Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.
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Affiliation(s)
- Konstantinos D Andreanos
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece.
| | - Kate Hashemi
- Faculty of Biology and Medicine, Jules Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Myrsini Petrelli
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Droutsas
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Georgalas
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
| | - George D Kymionis
- 1st Department of Ophthalmology, 'G. Gennimatas Hospital', National and Kapodistrian University of Athens, Athens, Greece
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Refractive Surgery in Pediatric Patients. CURRENT OPHTHALMOLOGY REPORTS 2017. [DOI: 10.1007/s40135-017-0147-y] [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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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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Efficacy of Intrastromal Corneal Ring Segments Combined With Flash Collagen Cross-Linking in Keratoconus. Cornea 2017; 36:144-147. [PMID: 28060059 DOI: 10.1097/ico.0000000000001104] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate outcomes, efficacy, and safety of intrastromal corneal ring segment implantation for treatment of keratoconus combined with collagen cross-linking (CXL) with 1-year follow-up. METHODS One hundred nineteen eyes of 82 patients with keratoconus (37 females) underwent femtosecond (Intralase FS; Abbott Medical Optics, Inc) laser-assisted intrastromal corneal ring segment implantation (INTRASEG; Gamma Vision) with flash CXL (18 mW/cm for 5 minutes). The outcome measures were uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), subjective refractive error, keratometry values, and corneal thickness. RESULTS Mean age of patients at implantation was 31 years (range 12-63, SD 9.5). According to the Amsler-Krumeich scale of keratoconus severity, 62 eyes were type 1 (52%), 43 eyes, type 2 (36%), and 14 eyes, type 3 (11.8%). Statistically significant improvement of UDVA/CDVA and reduction in the mean cylinder and mean keratometry at 1 year were observed. Mean UDVA (logMAR) was 1.11 ± 0.61 (SD) preoperatively and 0.54 ± 0.58 (SD) postoperatively (P < 0.001). Mean CDVA was 0.52 ± 0.18 (SD) preoperatively and was 0.14 ± 0.17 (P < 0.0001) postoperatively. Preoperative Kmax was 48.75 diopters (D) (range 41.0-55.0 D), and postoperative Kmax was 46.18 D (P < 0.0006); preoperative Kmin was 44.69 D (SD) 3.59 and postoperative Kmin was 43.00 D (SD) 2.53. The mean cylinder was -5.19 D preoperatively (range -0.80 to -8.80 D) and -2.6 D (range -1.00 to -7.25) postoperatively. Mean corneal pachymetry was 486.6 μm (range 391-591). No intraoperative complications occurred. No patient lost any lines of UDVA or CDVA. CONCLUSIONS Implantation of the INTRASEG with the Intralase combined with flash CXL was apparently safe and effective in treatment of keratoconus. The variety of options in thickness and arc length of the segments enables more precise correction of keratoconus and refractive errors.
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Polar Value Analysis of Corneal Astigmatism in Intrastromal Corneal Ring Segment Implantation. J Ophthalmol 2016; 2016:7127534. [PMID: 27795856 PMCID: PMC5066027 DOI: 10.1155/2016/7127534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/02/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose. To evaluate surgically induced astigmatism (SIA) and the average corneal power change in symmetric intrastromal corneal ring segment (ICRS) implantation. Methods. The study included 34 eyes of 34 keratoconus patients who underwent symmetric Intacs SK ICRS implantation. The corneal pocket incision meridian was the preoperative steep meridian. Corneal power data were obtained before and 3 months after Intacs SK ICRS implantation using scanning-slit topography. Polar value analysis was used to evaluate the SIA. Hotelling's trace test was used to compare intraindividual changes. Results. Three months postoperatively, the combined mean polar value for SIA changed significantly (Hotelling's T2 = 0.375; P = 0.006). The SIA was 1.54 D at 99° and the average corneal power decreased significantly by 3.8 D. Conclusion. Intacs SK ICRS placement decreased the average corneal power and corneal astigmatism compared to the preoperative corneal power and astigmatism when the corneal pocket incision was made at the preoperative steep meridian.
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Measuring Intraocular Pressure in Patients With Keratoconus With and Without Intrastromal Corneal Ring Segments. J Glaucoma 2016; 26:71-76. [PMID: 27661992 DOI: 10.1097/ijg.0000000000000549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare intraocular pressure (IOP) measurements made using 5 tonometers in keratoconic eyes with and without intrastromal corneal ring segments. METHODS AND PATIENTS This was an observational case series study. A total of 147 eyes of 147 patients with keratoconus, 74 of which had undergone corneal ring segment placement, were prospectively evaluated. IOP was measured using the tonometers Tonopen XL, Pascal dynamic contour tonometer, iCare Pro, ocular response analyzer (ORA), and Goldmann applanation (GAT) in random order. The Bland-Altman method was used to examine interinstrument agreement. Effects on readings of central corneal thickness, corneal curvature, and corneal astigmatism were assessed by multivariate regression analysis. RESULTS Smallest mean IOP differences with GAT measurements in eyes without and with ring segments, respectively, were detected for iCare Pro [0.2 (2.9) mm Hg and 0.4 (3.0) mm Hg, P=0.914] and greatest differences for ORA Goldmann-correlated IOP [5.8 (3.3) mm Hg and 6.0 (3.1) mm Hg, P=0.363]. Best agreement with GAT was shown by iCare Pro (ICC=0.829; 95% CI, 0.721-0.896) and worse agreement by ORA corneal-compensated IOP (ICC=-0.145; 95% CI, -0.826 to 0.283). All but the dynamic contour tonometer readings were influenced by central corneal thickness, yet these measurements were affected by the presence of ring segments (P=0.017) and corneal astigmatism (P=0.030). Corneal curvature only affected ORA Goldmann-correlated IOP (P=0.029). CONCLUSIONS All 5 tonometers provided reliable IOP readings in the keratoconic eyes regardless of the presence of corneal ring segments. iCare Pro readings were most consistent with GAT, whereas ORA readings were least consistent with this reference standard.
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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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Zare MA, Mehrjardi HZ, Afarideh M, Bahrmandy H, Mohammadi SF. Visual, Keratometric and Corneal Biomechanical Changes after Intacs SK Implantation for Moderate to Severe Keratoconus. J Ophthalmic Vis Res 2016; 11:17-25. [PMID: 27195080 PMCID: PMC4860981 DOI: 10.4103/2008-322x.180698] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: To report visual outcomes and corneal biomechanical changes after femtosecond-assisted Intacs SK implantation in keratoconic eyes. Methods: This prospective interventional case series is comprised of 32 keratoconic eyes of 25 patients with mean age of 23.8 ± 5.4 years. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, manifest refraction spherical equivalent (MRSE), keratometry, central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF) were measured preoperatively, and 1, 3 and 6 months postoperatively. Results: Mean UDVA improved from 0.81 ± 0.3 LogMAR preoperatively to 0.53 ± 0.2 LogMAR six months postoperatively (P < 0.001). At 6 months, MRSE was significantly reduced only in eyes with moderate KCN (mean change, +2.61 ± 0.54 diopter [D]; P< 0.001). A significant improvement in sphere (mean change, +1.92 ± 0.37 D; P< 0.001) and mean keratometry (mean change, -3.34 ± 0.47D; P< 0.001) were observed. CCT increased from 446.1 ± 38 μm preoperatively to 462.2 ± 50 μm at six months (P < .001). CRF decreased from 6.5 ± 1.6 mmHg to 5.9 ± 1.1 mmHg six months after surgery (P = 0.02). CDVA, refractive cylinder and CH did not change significantly (P = 0.48, 0.203 and 0.55, respectively). Linear regression analysis disclosed that a decrease in CCT and moderate KCN are associated with higher CRF (standardized B,-0.513 and 0.314;P= 0.004 and 0.024, respectively; Adjusted R square = 0.353). Conclusion: Visual, refractive and keratometric indices remarkably improved in a parallel fashion. CRF was inversely associated with CCT. Changes in CRF represent the trend of changes in corneal biomechanics and thickness during the early postoperative months.
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Affiliation(s)
- Mohammad Ali Zare
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Z Mehrjardi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooman Bahrmandy
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Farzad Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Janani L, Jadidi K, Mosavi SA, Nejat F, Naderi M, Nourijelyani K. MyoRing Implantation in Keratoconic Patients: 3 years Follow-up Data. J Ophthalmic Vis Res 2016; 11:26-31. [PMID: 27195081 PMCID: PMC4860982 DOI: 10.4103/2008-322x.180713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate long-term follow-up data on implantation of a full-ring intra-corneal implant (MyoRing) for management of keratoconus. Methods: A total of 40 keratoconic eyes of 37 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, GmbH, Linz, Austria) and completed 3 years of follow-up appointments were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and evaluated preoperatively, and 3 years, postoperatively. Results: No intraoperative complications were observed in this case series. Three years postoperatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (P < 0.05 for all comparisons). UDVA was significantly improved from 1.14 ± 0.27 to 0.30 ± 0.21 LogMAR (P = 0.001), CDVA was also improved from 0.52 ± 0.23 to 0.18 ± 0.12 LogMAR (P = 0.001), SE was decreased by 4.35 diopters (D) and average keratometric values were reduced by 2.34 D (P = 0.001). Overall, 81% of subjects were moderately to highly satisfied 3 years after surgery and 64.90% agreed to have the fellow eye implanted with MyoRing. Conclusion: MyoRing implantation using the Pocket Maker microkeratome was found to be a minimally invasive procedure for improving visual acuity and refraction in the majority of the patients with keratoconus.
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Affiliation(s)
- Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Khosrow Jadidi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | | | - Farhad Nejat
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | - Mostafa Naderi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | - Keramat Nourijelyani
- Department of Epidemiology and Biostatistics, School of Public Health, 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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Gauthier AS, Friot M, Montard R, Saleh M, Delbosc B. Anneaux intra-cornéens Ferrara implantés au laser femtoseconde dans le traitement du kératocône : résultats fonctionnels à 1 an. J Fr Ophtalmol 2016; 39:428-36. [DOI: 10.1016/j.jfo.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/15/2015] [Accepted: 01/04/2016] [Indexed: 11/25/2022]
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41
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Hydrogel ocular sealant for wound closure during intrastromal corneal ring segment implantation. J Cataract Refract Surg 2016; 42:515-9. [DOI: 10.1016/j.jcrs.2016.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/24/2016] [Accepted: 03/06/2016] [Indexed: 11/21/2022]
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Vega-Estrada A, Alio JL. The use of intracorneal ring segments in keratoconus. EYE AND VISION 2016; 3:8. [PMID: 26981548 PMCID: PMC4791885 DOI: 10.1186/s40662-016-0040-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/06/2016] [Indexed: 12/31/2022]
Abstract
Keratoconus is a corneal degeneration that usually appears during puberty and may seriously deteriorate the quality of life of the patients. This corneal disease is today the first indication of corneal transplantation in young patients. Until the last decade of the XX century, keratoplasty procedures were the only alternative to treat this pathological condition. In the beginning of the XXI century, intracorneal ring segments implantation was proposed as a therapeutic choice for treating keratoconus patients. Since then, several published articles have reported the benefits of this surgical procedure in treating this type of corneal ectatic disorder. The purpose of the present investigative work is to summarize the characteristic of the intracorneal ring segments and also to review the different features published in the literature in relation to this surgical technique for the treatment of keratoconus patients.
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Affiliation(s)
- Alfredo Vega-Estrada
- Keratoconus Unit, Vissum Alicante, Calle Cabañal, 1 Edificio Vissum, 03016 Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge L Alio
- Keratoconus Unit, Vissum Alicante, Calle Cabañal, 1 Edificio Vissum, 03016 Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Hashemi H, Amanzadeh K, Miraftab M, Asgari S. Femtosecond-assisted intrastromal corneal single-segment ring implantation in patients with keratoconus: a 12-month follow-up. Eye Contact Lens 2016; 41:183-6. [PMID: 25603435 DOI: 10.1097/icl.0000000000000106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine visual rehabilitation in patients with keratoconus who received femtosecond-assisted intrastromal corneal single-segment ring implantation. METHODS This prospective study was conducted on 62 eyes of 45 patients with keratoconus who received single-segment Intacs. The FS200 femtosecond laser was used for tunnel creation. Patients were examined for astigmatism, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and manifest refraction spherical equivalent (MRSE) before the operation and 1, 6, and 12 months after operation. Scheimpflug imaging including minimum keratometry reading (min-K), maximum keratometry reading (max-K), average of minimum and maximum keratometry readings (mean-K), central corneal thickness (CCT), asphericity (Q-value), index of surface variance (ISV), index of vertical asymmetry (IVA), keratoconus index (KI), center keratoconus index (CKI), index of height asymmetry (IHA), index of height decentration (IHD), and minimum sagittal curvature (Rmin) was performed before and 12 months after the operation. RESULTS The mean preoperative UCVA was 20/130, which increased to 20/62 1 year after the operation (P < 0.001). The mean BCVA in the last follow-up was 20/32, which improved when compared with preoperative BCVA (20/40) (P = 0.008). One year after the operation, MRSE and cylinder decreased to 1.33 ± 1.90 diopter (D) and 0.46 ± 1.50 D, respectively (P < 0.001 for both). Min-K, max-k, and mean-k reduced to 1.67 ± 0.1.40 D, 2.08 ± 1.84 D, and 1.85 ± 1.30 D (P < 0.001 for all). Q-value decreased to 0.81 ± 1.14 (P < 0.001). In contrast, CKI had a significant increase of 0.02 (P = 0.002). Other evaluated indexes did not show any significant differences. CONCLUSION Implantation of the single-segment ring in patients with keratoconus improved vision because of regularizing the cornea and centralization of the corneal cone.
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Affiliation(s)
- Hassan Hashemi
- Noor Ophthalmology Research Center (H.H., K.A., M.M.), Noor Eye Hospital, Tehran, Iran; and Department of Epidemiology and Biostatistics (S.A.), School of Public Health, Tehran University of Medical Sciences, International Campus (TUMS-IC), Tehran, Iran
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Naderi M, Jadidi K, Mosavi SA, Daneshi SA. Transepithelial Photorefractive Keratectomy for Low to Moderate Myopia in Comparison with Conventional Photorefractive Keratectomy. J Ophthalmic Vis Res 2016; 11:358-362. [PMID: 27994803 PMCID: PMC5139546 DOI: 10.4103/2008-322x.194070] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: To compare the effectiveness, safety and stability of the results of transepithelial photorefractive keratectomy (tPRK) with conventional photorefractive keratectomy (PRK) for low to moderate myopia. Methods: In this prospective non-randomized case-control study, patients with low to moderate myopia were assigned to the tPRK group (cases) or the PRK group (controls). In the tPRK group, eyes were treated using the Amaris excimer laser (SCHWIND eye-tech-solutions GmbH and Co. KG, Germany). Outcome measures included postoperative pain using McGill Pain Questionnaire, epithelial healing time, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, and safety and efficacy indexes which were compared between the study groups. Results: Three hundred forty eyes of 170 patients were enrolled in this study. Each study group comprised of 170 eyes of 85 patients. There was a significant difference between the two groups regarding the postoperative pain scores in favor of the tPRK group (P = 0.04). The tPRK group had a shorter epithelial healing time than the conventional PRK group postoperatively (P = 0.01). Mean UCVA was significantly better in the case group than in the control group at the postoperative month 2 (P = 0.01). Regarding the safety and efficacy indexes, the tPRK group had better results than the conventional PRK group (P < 0.01 for both comparisons). Conclusion: Transepithelial PRK seems to be superior to conventional PRK for treatment of low to moderate myopia in terms of postoperative pain, epithelial healing time, visual recovery and safety and efficacy indexes.
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Affiliation(s)
- Mostafa Naderi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran; Bina Eye Hospital Research Center, Tehran, Iran
| | - Khosrow Jadidi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Seyed Aref Daneshi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran
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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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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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Recent advances in the treatment of corneal ectasia with intrastromal corneal ring segments. Curr Opin Ophthalmol 2015; 26:273-7. [DOI: 10.1097/icu.0000000000000163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vega-Estrada A, Alió JL, Plaza-Puche AB. Keratoconus progression after intrastromal corneal ring segment implantation in young patients: Five-year follow-up. J Cataract Refract Surg 2015; 41:1145-52. [DOI: 10.1016/j.jcrs.2014.08.045] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/19/2014] [Accepted: 08/22/2014] [Indexed: 11/15/2022]
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Measuring Intraocular Pressure After Intrastromal Corneal Ring Segment Implantation With Rebound Tonometry and Goldmann Applanation Tonometry. Cornea 2015; 34:516-20. [DOI: 10.1097/ico.0000000000000374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Le crosslinking du collagène dans le kératocône. J Fr Ophtalmol 2015; 38:445-62. [DOI: 10.1016/j.jfo.2014.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/07/2014] [Accepted: 12/09/2014] [Indexed: 11/20/2022]
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