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Keskin Perk FFN, Tanriverdi C, Karaca ZY, Tran KD, Kilic A. Long-Term Results of Sterile Corneal Allograft Ring Segments Implantation in Keratoconus Treatment. Cornea 2024:00003226-990000000-00581. [PMID: 38900741 DOI: 10.1097/ico.0000000000003592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/05/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To evaluate the efficacy and safety of sterile corneal allograft ring segments implantation for the treatment of keratoconus by analyzing long-term visual, refractive, and tomographic clinical outcomes. METHODS This prospective study included 62 eyes of 49 patients with keratoconus who underwent corneal allograft ring segments implantation at Istanbul Medipol University Faculty of Medicine between February 2020 and August 2022. Surgical outcomes using the Istanbul nomogram were evaluated in patients preoperatively and postoperatively at 1 month, 6 months, 1 year, and 3 years. Outcomes measured were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), spherical refraction (SR), cylindrical refraction (CR), topographic keratometric values, and corneal thickness at the thinnest point. RESULTS Preoperative mean UDVA and CDVA (LogMAR) were 0.96 ± 0.50 and 0.72 ± 0.47, respectively, and increased to 0.41 ± 0.34 and 0.22 ± 0.19 at the last visit (P < 0.001). There was a significant decrease in SE, SR, and keratometric values postoperatively (P < 0.001). There was no difference in CR and thinnest corneal thickness values (P = 0.333 and 0.154, respectively). The stromal and epithelial thicknesses measured by anterior segment optical coherence tomography were stabilized at 6 months and 1 year, respectively. No major complications or side effects were observed intraoperatively or postoperatively. CONCLUSIONS This study demonstrated that sterile corneal allograft ring segments implantation is a safe and feasible treatment for keratoconus, yielding notable long-term visual outcomes with minimal implant-related complications.
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Affiliation(s)
| | - Cafer Tanriverdi
- Department of Ophthalmology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - Zeki Yigit Karaca
- Department of Ophthalmology, Istanbul Medipol University, Faculty of Medicine, Istanbul, Turkey
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Sara M, Hui A, Yasir M, Peguda HK, Kalaiselvan P, Willcox M. Intrastromal Corneal Ring Implants Associated Bacterial Infections. Curr Eye Res 2024:1-9. [PMID: 38780797 DOI: 10.1080/02713683.2024.2354438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE This study examines the incidence of infection and resistance associated with Intracorneal Ring Segment (ICRS) implantation, a common outpatient surgical treatment for correcting refractive errors and corneal ectatic diseases. Although ICRS procedures are typically safe and reversible, there is a low but notable risk of microbial infections, which require prompt and sometimes invasive treatment. METHODS Three electronic databases, PubMed, Web of Science (WoS), and Scopus, were utilised to search for literature according to PRISMA guidelines to identify infections related to the implantation of ICRS in the cornea between January 2000 and December 2022. RESULTS Gram-positive organisms were involved in 86% of cases: 35.7% S. aureus, 25% coagulase-negative staphylococci species, 17.8% streptococci and 7.1% Nocardia species. Less commonly recorded were Gram-negative bacteria (14%), with Pseudomonas aeruginosa (circa 10%) and Klebsiella pneumonia (4%) being the most common Gram-negative bacteria. In rare cases, fungi have also been reported. ICRS-related bacterial infections can be categorised into early or late onset. Early onset infection typically manifests within the first few weeks after implantation and is often associated with contamination during surgery, unhygienic practices, or inadequate sterilisation techniques. On the other hand, late-onset infection may develop months or even years after the initial procedures and may be associated with persistent bacterial colonisation, secondary infections, or prolonged use of prophylactic antibiotics. S aureus is encountered in both early and late-onset infections, while Nocardia species and K. pneumoniae have generally been reported to occur in late-onset infections. In addition, vision recovery from S. aureus infections tends to be poor compared to other bacterial infections. CONCLUSION S. aureus is a predominant pathogen that often requires surgical intervention with poor outcomes. Early infections result from incision gaps and ring segment rubbing, while late infections are linked to prolonged antibiotic use. Further research is needed on novel antimicrobial ICRS to procure the vision.
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Affiliation(s)
- Manjulatha Sara
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Alex Hui
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Ocular Research and Education, University of Waterloo, Waterloo, Ontario, Canada
| | - Muhammad Yasir
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | - Hari Kumar Peguda
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Mark Willcox
- School of Optometry and Vision Science, UNSW Sydney, Sydney, New South Wales, Australia
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Goebel GJ, Price DA, Price MO, Price FW. Functional Approach to IOL Selection in Eyes With Combined Cataract and Keratoconus With an Option for Refractive Lens Exchange. J Refract Surg 2024; 40:e208-e217. [PMID: 38593256 DOI: 10.3928/1081597x-20240311-01] [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: 04/11/2024]
Abstract
PURPOSE To evaluate spherical intraocular lens (IOL) implantation for cataracts in keratoconic eyes followed by optional refractive toric lens exchange to improve uncorrected visual acuity. METHODS This retrospective study evaluated cataract surgery outcomes in keratoconic eyes. Eyes treated with a spherical IOL targeted for -2.00 diopters (D) either achieved acceptable manifest refraction and desired exchange with a toric IOL (Group 1); achieved satisfactory manifest refraction and chose to use spectacles or contact lenses (Group 2); or did not achieve acceptable refraction and used contact lenses (Group 3). Group 4 had single-stage toric IOL implantation with plano target. Corrected and uncorrected distance visual acuity (CDVA and UDVA) and keratometry were analyzed. RESULTS Groups 1 to 4 had 18, 23, 18, and 26 eyes, respectively. A staged toric exchange resulted in significantly better (P = .02) UDVA (mean: 0.15 logMAR; 20/25 Snellen) than initial toric IOL implantation (0.24 logMAR; 20/30 Snellen). All toric IOL exchange eyes achieved 20/30 or better CDVA and 94% had 20/40 or better UDVA. Mean manifest cylinder significantly decreased from 3.39 D before lens exchange to 1.10 D postoperatively. CONCLUSIONS Initial implantation of a spherical IOL in keratoconic eyes allows basing toric calculations on the manifest refraction, which may be more reliable than keratometry measurements in keratoconic eyes. UDVA after staged toric IOL exchange was significantly better than after initial toric IOL implantation. Importantly, by staging use of toric lenses, the authors avoided cases where patients required a rigid contact lens after a toric IOL was implanted. [J Refract Surg. 2024;40(4):e207-e217.].
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Jacob S, Agarwal A, Awwad ST, Mazzotta C, Parashar P, Jambulingam S. Customized corneal allogenic intrastromal ring segments (CAIRS) for keratoconus with decentered asymmetric cone. Indian J Ophthalmol 2023; 71:3723-3729. [PMID: 37991313 PMCID: PMC10788746 DOI: 10.4103/ijo.ijo_1988_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/01/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
Corneal allogenic intrastromal ring segments (CAIRS) refer to the intracorneal placement of fresh, unprocessed, processed, preserved, or packaged allogenic rings/segments of any type/length. We described uniform-thickness CAIRS previously. We now describe a new technique of customized CAIRS to personalize the flattening effect as per individual topography. A prospective interventional case series of patients with pericentral/ paracentral decentered cones and gradation of keratometry with one side steeper than the other was conducted. Individually customized tapered CAIRS with variable volume, arc length, taper length, and gradient of taper were implanted. In total, 32 eyes of 29 patients with at least 1-year follow-up were included. Special double-bladed trephines and a CAIRS customizer template allowed the creation of individually customized CAIRS. Mean uncorrected distance visual acuity (UDVA) and spectacle-corrected distance visual acuity improved from 0.22 to 0.47 (P = 0.000) and from 0.76 to 0.89 (P = 0.001), respectively. Significant improvement was seen in K1, K2, Km, Kmax, topographic astigmatism, Q-value, sphere, cylinder, spherical equivalent, Root Mean Square (RMS), Higher Order Aberrations (HOA), and vertical coma (P < 0.01, 0.05). There was no significant change in the width or height of CAIRS between 1 month and last visit on anterior-segment optical coherence tomography. Five eyes continued to remain at the same UDVA, 27 eyes had at least 2 lines, and 13 eyes had at least 3 or more lines improvement in UDVA. The maximum improvement in UDVA was 7 lines. A significant difference in flattening was obtained at different zones across the tapered CAIRS. Thus, differential flattening was achieved across the cone based on the customization plan. Personalized customization was possible for each cornea, unlike limited models of progressive-thickness synthetic segments. Allogenic nature, greater customizability, efficacy, and absent need for large inventories are advantages compared to synthetic segments.
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Affiliation(s)
- Soosan Jacob
- Department of Cornea, Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
- Department of Cornea, Dr. Agarwal's Refractive and Cornea Foundation, Chennai, Tamil Nadu, India
| | - Amar Agarwal
- Department of Cornea, Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
| | - Shady T Awwad
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Cosimo Mazzotta
- Departmental Ophthalmology Unit, Alta Val D'elsa Hospital, USL Toscana Sudest, Italy
- Siena Crosslinking Center, Italy
| | - Parnika Parashar
- Department of Cornea, Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
- Department of Cornea, Dr. Agarwal's Refractive and Cornea Foundation, Chennai, Tamil Nadu, India
| | - Sambath Jambulingam
- Department of Cornea, Dr. Agarwal's Eye Hospital and Eye Research Centre, Chennai, Tamil Nadu, India
- Department of Cornea, Dr. Agarwal's Refractive and Cornea Foundation, Chennai, Tamil Nadu, India
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Albertazzi R, Rocha-de-Lossada C, Perrone LD, Valvecchia G, Perrone F, Ferlini L, Taboada D, Roude AL. Late-onset distal-apical intracorneal ring-segments keratopathy: an analysis of a large sample in a multicenter study. Int Ophthalmol 2023; 43:3923-3933. [PMID: 37531002 DOI: 10.1007/s10792-023-02793-0] [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: 04/11/2022] [Accepted: 06/22/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE To review the prevalence and describe the characteristics, of cases with late-onset intracorneal ring segments (ICRS) keratopathy in a multicenter study. METHODS A retrospective multicentric case-series study was performed in a specialized keratoconus service, from Buenos Aires, Argentina. An electronic clinical chart from patients with ICRS keratopathy between January 1999 and January 2019 was reviewed. We included cases with late-onset distal-apical ICRS keratopathy, which was defined as a persistent corneal lesion developed 12 months or later after implantation, located over, around, or closer to the ICRS. All the surgeries were performed by a manual corneal tunnel creation technique. Samples were taken to rule out infectious etiology. RESULTS From 5217 eyes that underwent ICRS implantation, 13 cases (0.24%) were detected. The keratopathy onset was 72 ± 42.98 months (29-133) after ICRS implantation. Cultures were negative in all cases. An ICRS exchange was made for five cases in stage I and four in stage II. Four cases presented with partial ICRS extrusion in stage III. ICRS exchange was possible in two of them and a penetration keratoplasty was necessary for the rest. All cases remained stable 1 year after surgical procedures. CONCLUSIONS A late-onset distal-apical ICRS keratopathy was detected with low prevalence (0.24%) in a large sample. It was classified into three stages according to its severity. Different treatments were selected for each stage, obtaining stable results 1 year after treatment.
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Affiliation(s)
- Roberto Albertazzi
- Centro de Ojos Quilmes (Keratoconus Service), Humberto Primo, 298, 1878, Quilmes, Buenos Aires, Argentina.
| | - Carlos Rocha-de-Lossada
- Qvision-Vithas, Almeria; Vithas Málaga (Department of Ophthalmology; Spain), Almería, Spain
- Department of Ophthalmology, Regional University Hospital of Málaga; Department of Surgery, Ophthalmology, Universidad de Sevilla, Málaga, Spain
| | - Luciano D Perrone
- Centro de Ojos Quilmes (Keratoconus Service), Humberto Primo, 298, 1878, Quilmes, Buenos Aires, Argentina
| | - Gerardo Valvecchia
- Centro de Ojos Quilmes (Keratoconus Service), Humberto Primo, 298, 1878, Quilmes, Buenos Aires, Argentina
| | - Franco Perrone
- Centro de Ojos Quilmes (Keratoconus Service), Humberto Primo, 298, 1878, Quilmes, Buenos Aires, Argentina
| | - Leonardo Ferlini
- Centro de Ojos Quilmes (Keratoconus Service), Humberto Primo, 298, 1878, Quilmes, Buenos Aires, Argentina
| | - Delfina Taboada
- Centro de Ojos Quilmes (Keratoconus Service), Humberto Primo, 298, 1878, Quilmes, Buenos Aires, Argentina
| | - Alfredo L Roude
- Clínica de Ojos Nano (Cornea Service), Olivos, Buenos Aires, Argentina
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Sheludchenko VM, Osipyan GA, Khraystin K, Dzhalili RA, Abukerimova AK. [Deep anterior lamellar keratoplasty in extrusion of an incomplete intrastromal corneal ring segment (clinical observation)]. Vestn Oftalmol 2023; 139:75-79. [PMID: 36924517 DOI: 10.17116/oftalma202313901175] [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: 03/18/2023]
Abstract
Intrastromal corneal ring segments (ICRS) of in various shapes are used to correct structural changes in the cornea and improve visual acuity in keratoconus (KC). The most serious complications of the technology infection, vascular ingrowth, and extrusion. In this study a 44-year-old patient underwent deep anterior lamellar keratoplasty (DALK) 5 years after implantation of ICRS in the shape of an incomplete ring to treat its extrusion of up to 30%, vascular ingrowth into the cornea and corneal syndrome. The following DALK technique was used: excision of the free part of the corneal segment, removal of the remaining part of the corneal segment, excision of 80% of thickness of the corneal block with a 8.5-mm trepan, pneumatic dissection of the stroma down to the Descemet membrane (DM), removal of the remaining stroma on the viscoelastic pillow, laying and suture fixation of the donor graft. There were no complications during the postoperative period, the graft remained transparent for up to 10 months. Uncorrected visual acuity (UCVA) increased from 0.01 to 0.4, best corrected visual acuity (BCVA) increased from 0.3 to 0.7. The number of endothelial cells decreased from 2980 to 2670 cells/mm2 (10.4%). This clinical case demonstrates that DALK surgery can be a reliable method of patient rehabilitation in cases of extrusion of ICRS in the shape of an incomplete ring and vascular ingrowth.
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Affiliation(s)
| | - G A Osipyan
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - Kh Khraystin
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - R A Dzhalili
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Haciagaoglu S, Tanriverdi C, Keskin FFN, Tran KD, Kilic A. Allograft corneal ring segment for keratoconus management: Istanbul nomogram clinical results. Eur J Ophthalmol 2022; 33:11206721221142995. [PMID: 36464653 DOI: 10.1177/11206721221142995] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
PURPOSE To evaluate the clinical feasibility and visual outcomes of allograft corneal ring segment implantation for the treatment of keratoconus. METHODS This case series, included forty-four eyes of 32 patients with a 6-month follow-up. All cases were treated according to the Istanbul nomogram. In the Istanbul Nomogram, corneal tunnels of 4 × 7.5 mm diameters are created at depth of 200 μm and implanted with sterile allograft corneal rings (KeraNaturalTM, Lions VisionGift, Portland, OR, USA) at the cone location. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and keratometric values were compared preoperatively versus postoperatively. RESULTS There was significant improvement in UDVA, CDVA, SE and topographic keratometric values. The mean preoperative CDVA (Snellen, decimal) increased from 0.29 ± 0.20, to 0.56 ± 0.26 (P < 0.001), at the last visit. There was no statistically significant difference between preoperative and postoperative thinnest pachymetry values (P = 0.509). No major complications or adverse event were observed during and after the operation. CONCLUSIONS The results of this pilot study show that sterile allograft corneal ring segments may be safe, effective and enhance the visual performance of keratoconus patients. Larger clinical studies are needed to demonstrate the effectiveness and safety with long term follow-up.
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Affiliation(s)
- Sezer Haciagaoglu
- Faculty of Medicine, Department of Ophthalmology, Medipol University, Istanbul, Turkey
| | - Cafer Tanriverdi
- Faculty of Medicine, Department of Ophthalmology, Medipol University, Istanbul, Turkey
| | | | | | - Aylin Kilic
- Faculty of Medicine, Department of Ophthalmology, Medipol University, Istanbul, Turkey
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Kozhaya K, Mehanna CJ, Jacob S, Saad A, Jabbur NS, Awwad ST. Management of Anterior Stromal Necrosis After Polymethylmethacrylate ICRS: Explantation Versus Exchange With Corneal Allogenic Intrastromal Ring Segments. J Refract Surg 2022; 38:256-263. [PMID: 35412922 DOI: 10.3928/1081597x-20220223-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate management of keratoconic eyes with anterior stromal necrosis overlying the intracorneal ring segment (ICRS), by either ICRS explantation alone or exchange with corneal allogenic intrastromal ring segments (CAIRS). METHODS Among 643 Intacs SK (Additional Technology, Inc) inserted at one institutional center, 16 eyes (15 patients) with overlying spontaneous anterior stromal necrosis were identified. Data included size of stromal defect and refractive and topographical findings before ICRS insertion, before anterior stromal necrosis, and 6 months after intervention. RESULTS The 10-year incidence of anterior stromal necrosis after femtosecond laser-assisted ICRS insertion was 5.5%. Eight eyes underwent ICRS removal only and 8 eyes had ICRS exchanged with CAIRS. In the first group, CDVA worsened from 0.14 before melt to 0.28 logMAR after removal (P = .10), simulated keratometry (SimK) and maximum axial keratometry (Kmax) increased from 44.73 to 46.34 diopters (D) (P = .14) and from 49.23 to 52.26 D (P = .14), respectively, and coma worsened from 0.87 to 1.52 D (P = .02). In the CAIRS group, CDVA of 0.16 before melt improved to 0.11 logMAR postoperatively (P > .99), and topographic indices stabilized with SimK, Kmax, and coma mildly altering from 45.31 to 45.44 D (P > .99), from 49.25 to 49.64 D (P > .99) and from 0.87 to 0.81 D (P > .99), respectively. Whether the ICRS were explanted or exchanged, the visual and topographic mean values were better than those reported before ICRS implantation, whereas higher order aberrations in eyes without CAIRS regressed to levels before ICRS insertion. At the site of melt, thinnest residual stromal thickness averaged 327 µm with ICRS removal and 490 µm with CAIRS. Eyes with larger melt areas resulted in less optimal results with CAIRS implantation. CONCLUSIONS Early experience in the management of anterior stromal necrosis by exchange of polymethylmethacrylate ICRS with CAIRS seems to avoid stromal thinning and confer better visual and topographic results, which were more pronounced with thicker segments. The benefit of CAIRS in large stromal melts needs to be investigated. [J Refract Surg. 2022;38(4):256-263.].
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Nuzzi R, Tripoli F, Rossi A, Ghilardi A. A Combined Procedure of Intrastromal Corneal Rings Explantation and Penetrating Keratoplasty in a Patient With Keratoconus: A Case Report. Front Med (Lausanne) 2022; 9:853702. [PMID: 35360745 PMCID: PMC8961690 DOI: 10.3389/fmed.2022.853702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/18/2022] [Indexed: 12/05/2022] Open
Abstract
Keratoconus is a non-inflammatory and degenerative corneal ectasia that determinate progressive steepening of paracentral cornea with development of irregular astigmatism and visual function deterioration. According to the stage of the pathology, different methods of correction can be used: rigid contact lenses may be used to alter corneal shape and partially correct astigmatism, corneal collagen cross-linking (CXL) and intrastromal corneal ring segment (ICRS) implantation can reinforce corneal stroma to slow disease progression. Late-stage treatment comprehend anterior lamellar keratoplasty or penetrating keratoplasty. We evaluated a 31-year-old patient who was subjected to bilateral ICRS implantation combined with CXL due to keratoconus. This led, after 9 months, to ring extrusion in his left eye, corneal thinning and microperforation into the aqueous chamber with residual irregular astigmatism of 4.50 D. cyl. 10°. The patient underwent ICRS explantation and PKP during the same surgical session. After 15 months of follow-up, the BCVA was 0.2 LogMAR with a residual astigmatism of 6.3 dpt.
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Jafarinasab M, Hadi Y. Femtosecond laser-assisted peripheral additive stromal keratoplasty for treatment of primary corneal ectasia: Preliminary outcomes. Indian J Ophthalmol 2021; 69:2663-2668. [PMID: 34571610 PMCID: PMC8597526 DOI: 10.4103/ijo.ijo_3206_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: To report the preliminary results of a new surgical modality for the treatment of primary corneal ectasia, which consists of implanting allogeneic corneal tissue into the peripheral corneal stroma using a femtosecond laser system or femtosecond laser-assisted peripheral allogeneic stromal additive keratoplasty or FA-PASAK. Methods: This prospective, noncomparative case series includes patients with primary corneal ectasia including keratoconus and pellucid marginal degeneration. In the operating room, one or two ring or crescent-shaped allogeneic corneal segments were prepared using a handmade double-bladed punch, which were then implanted by a specially designed device, into stromal channels in the peripheral recipient cornea fashioned with a femtosecond-laser system. Results: A total of 15 eyes of 13 patients with mean age of 31.73 years were operated. There were significant improvements in uncorrected (0.68 to 0.3 logMAR) and corrected (0.44 to 0.16 logMAR) visual acuity, mean sphere, mean spherical equivalent refractive error, and mean keratometry (steep, flat, and average). Topographic and refractive astigmatism did not change significantly. Complications included a single case of bacterial keratitis secondary to epithelial defect, which was controlled with topical antibiotics eventually leading to an uncorrected vision of 20/25 one year after surgery. Conclusion: The use of allogeneic corneal ring or crescent shape segments may be a safe and cost-effective treatment for primary corneal ectasia, whereas a nomogram is necessary to be devised for general use of the technique.
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Affiliation(s)
- Mohammadreza Jafarinasab
- Eye Research Center, Shahid Labbafi Nejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Hadi
- Eye Research Center, Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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David C, Kallel S, Trinh L, Goemaere I, Borderie V, Bouheraoua N. [Intracorneal ring segments in keratoconus management]. J Fr Ophtalmol 2021; 44:882-898. [PMID: 33895029 DOI: 10.1016/j.jfo.2020.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022]
Abstract
Intracorneal ring segments (ICRS), used in the management of keratoconus since the 2000s, have enjoyed significant technological development. Various types of ICRS exist, whose arc length, thickness, and diameter can be chosen according to the desired effect on the spherical equivalent, keratometry and asphericity. Individualized implantation strategies, based on each patient's topographic and tomographic pattern, are constantly evolving. The surgical procedure is standardized, and complications remain very rare. Combined procedures (corneal collagen cross-linking and refractive photokeratectomy±topo-guided, phakic and pseudophakic intraocular lenses) are increasingly used and require a good knowledge of the effect of ICRS alone on the keratoconic cornea. The objective of this review is to summarize clinical practices used in the visual rehabilitation of keratoconic patients using the ICRS+- combined procedures.
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Affiliation(s)
- C David
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France
| | - S Kallel
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France
| | - L Trinh
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France
| | - I Goemaere
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France
| | - V Borderie
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France; Inserm, CNRS, Sorbonne université, institut de la Vision, 17, rue Moreau, 75012 Paris, France
| | - N Bouheraoua
- INSERM-DGOS CIC 1423, CHNO des Quinze-Vingts, IHU ForeSight, 28, rue de Charenton, 75012 Paris, France; Inserm, CNRS, Sorbonne université, institut de la Vision, 17, rue Moreau, 75012 Paris, France.
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Hodge C, Chan C, Bali SJ, Sutton G. A review of corneal melting following kerato‐refractive surgery. Clin Exp Optom 2021; 96:14-9. [DOI: 10.1111/j.1444-0938.2012.00759.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/07/2012] [Accepted: 03/14/2012] [Indexed: 12/01/2022] Open
Affiliation(s)
- Christopher Hodge
- Vision Eye Institute, Chatswood, NSW, Australia,
- Sydney Medical School, The University of Sydney, Australia,
| | - Colin Chan
- Vision Eye Institute, Chatswood, NSW, Australia,
- Central Clinical School, The University of Sydney, Australia,
- School of Optometry and Vision Sciences, The University of New South Wales, Australia,
| | | | - Gerard Sutton
- Vision Eye Institute, Chatswood, NSW, Australia,
- Sydney Medical School, The University of Sydney, Australia,
- Central Clinical School, The University of Sydney, Australia,
- Sydney Medical School Foundation, Save Sight Institute, Sydney, NSW, Australia,
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D'Oria F, Abdelghany AA, Ledo N, Barraquer RI, Alio JL. Incidence and Reasons for Intrastromal Corneal Ring Segment Explantation. Am J Ophthalmol 2021; 222:351-358. [PMID: 33011155 DOI: 10.1016/j.ajo.2020.09.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the main causes of intrastromal corneal ring segment (ICRS) explantation and define the incidence rate. DESIGN Multicenter, observational consecutive case series. METHODS Consecutive cases of ICRSs explanted in the last 10 years were reviewed. Clinical data included age of the patients at explantation, reasons for implantation and explantation, date of implantation and explantation, tunnel creation technique, and ICRS type. Main outcomes measures were the reasons for ICRS removal and the incidence rate. RESULTS During the study period, 121 ICRSs (119 patients) were explanted, with an explantation rate of 5.60%. Functional failure (74 eyes, 61.16%) represents the main cause for ICRS removal: of them, 48 (39.67%) ICRSs were removed for refractive failure and 26 (21.49%) in the setting of a keratoplasty related to poor visual performance of the implanted eye. In addition, 47 eyes (38.84%) had ICRS removal for anatomic failure: among them, 36 (29.75%) were explanted for spontaneous extrusion (overall extrusion rate: 1.58%), 7 (5.79%) for suspected infectious keratitis, 3 (2.48%) for corneal melting, and 1 (0.83%) for corneal perforation. Mild cases of keratoconus were more prone to be explanted because of a loss of the initial improved visual acuity, whereas spontaneous extrusion happened often in advanced cases of keratoconus. CONCLUSIONS We report the largest series of ICRS explantation as of this writing. The main cause of explantation was functional refractive failure followed by spontaneous extrusion of the ICRS, that is, correlated to an anatomic failure at the site of implantation in an advanced disease.
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Affiliation(s)
- Francesco D'Oria
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Ahmed A Abdelghany
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain; Ophthalmology department, Faculty of Medicine, Minia University, Minia, Egypt
| | - Natalia Ledo
- Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael I Barraquer
- Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge L Alio
- Vissum Innovation, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
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Vidal Oliver L, Galotto López MÁ, Duch Samper A. AS-OCT in corneal melt overlying intrastromal ring segment. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:e85. [PMID: 32854980 DOI: 10.1016/j.oftal.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Affiliation(s)
- L Vidal Oliver
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España.
| | - M Á Galotto López
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - A Duch Samper
- Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, España; Facultad de Medicina, Universitat de Valància, Valencia, España
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Ibares-Frías L, Gallego-Muñoz P, Orive G, Anitua E, Cantalapiedra-Rodríguez R, Merayo-Lloves J, Martínez-García M. Potential Effect of Plasma Rich in Growth Factors-Endoret in Stromal Wound Healing in Additive Surgery. Ophthalmic Res 2019; 63:203-212. [DOI: 10.1159/000501507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
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16
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Bautista-Llamas MJ, Sánchez-González MC, López-Izquierdo I, López-Muñoz A, Gargallo-Martínez B, De-Hita-Cantalejo C, Sánchez-González JM. Complications and Explantation Reasons in Intracorneal Ring Segments (ICRS) Implantation: A Systematic Review. J Refract Surg 2019; 35:740-747. [DOI: 10.3928/1081597x-20191010-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/10/2019] [Indexed: 11/20/2022]
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Biologic stromal ring to manage stromal melting after intrastromal corneal ring segment implantation. J Cataract Refract Surg 2019; 45:1222-1225. [PMID: 31371149 DOI: 10.1016/j.jcrs.2019.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/30/2019] [Accepted: 05/16/2019] [Indexed: 11/23/2022]
Abstract
We report a new technique to replace a manufactured poly(methyl methacrylate) (PMMA) ring with a biologic stromal ring fashioned from human corneal donor tissue in eyes with stromal melting above the PMMA ring. The biologic stromal ring is prepared using manual or femtosecond laser trephination of a donor cornea to obtain a 360-degree ring that is denuded and adjusted to match the PMMA ring being replaced. The biologic ring is attached to the PMMA ring. The PMMA ring is pushed and retrieved from the other side, which installs the biologic ring in place. Six biologic stromal rings were implanted successfully in 5 eyes of 5 patients with previous stromal melting; no complications were reported up to 6 months postoperatively. The biologic stromal ring stopped and healed the melting, prevented further ring complications, and preserved the therapeutic refractive effect of the previously implanted PMMA ring.
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Osipyan GA, Sheludchenko VM, Khraystin K. [Modern methods of surgical treatment of keratectasias]. Vestn Oftalmol 2019; 135:138-143. [PMID: 31215545 DOI: 10.17116/oftalma2019135021138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Keratectasia (KE) ranks as one of the main causes of impaired vision. The pathology is characterized by progressive thinning of the cornea, which causes its deformation, the appearance of irregular astigmatism, and the reduction of vision acuity. The article reviews modern surgical methods that can be used to prevent the progression and treat various types of KE.
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Affiliation(s)
- G A Osipyan
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
| | - V M Sheludchenko
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
| | - Kh Khraystin
- Research Institute of Eye Diseases, 11, A, Rossolimo St., Moscow, Russian Federation, 119021
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Jacob S, Patel SR, Agarwal A, Ramalingam A, Saijimol AI, Raj JM. Corneal Allogenic Intrastromal Ring Segments (CAIRS) Combined With Corneal Cross-linking for Keratoconus. J Refract Surg 2018; 34:296-303. [PMID: 29738584 DOI: 10.3928/1081597x-20180223-01] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/22/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a new technique for the treatment of keratoconus using corneal allogenic intrastromal ring segments (CAIRS). METHODS CAIRS trephined from donor cornea using a double-bladed trephine were implanted into mid-depth femtosecond laser-dissected channels in the cornea of patients with keratoconus in the 6.5-mm optic zone, followed by accelerated corneal cross-linking (A-CXL)-either conventional or contact lens-assisted CXL (A-CACXL), depending on minimum corneal thickness. RESULTS Twenty patients (24 eyes) with stage 1 to 4 keratoconus (Amsler-Krumeich grading) were included. Mean follow-up was 11.58 ± 3.6 months (range: 6 to 18 months). There was significant improvement in uncorrected (2.79 ± 2.65 lines; range: 0 to 8 lines) and corrected (1.29 ± 1.33 lines; range: 0 to 5 lines) distance visual acuity, spherical equivalent, simulated maximum keratometry, steepest keratometry, topographic astigmatism, anterior and posterior best fit spheres, and mean power in the 3- and 5-mm zones. No eye showed progression during the entire follow-up. All segments remained well positioned and no segment-induced complications were seen. No other major intraoperative or postoperative complications were observed. CONCLUSIONS This pilot study indicates that CAIRS with CXL may be a simple, safe, and effective option for treating keratoconus. Further studies are recommended to determine long-term outcomes. [J Refract Surg. 2018;34(5):296-303.].
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Abstract
PURPOSE The aim of this study was to develop a modified ex vivo corneal cross-linking method that increases stromal resistance to enzymatic degradation for use as a carrier for the Boston keratoprosthesis. METHODS Ex vivo cross-linking of human corneas was performed using Barron artificial anterior chambers. The corneas were deepithelialized, pretreated with riboflavin solution (0.1% riboflavin/20% dextran), and irradiated with ultraviolet A (UV-A) light (λ = 370 nm, irradiance = 3 mW/cm) for various durations. The combined effect of UV-A and gamma (γ) irradiation was also assessed using the commercially available γ-irradiated corneal donors. The corneas were then trephined and incubated at 37°C with 0.3% collagenase A solution. The time to dissolution of each cornea was compared across treatments. RESULTS Deepithelialized corneas (no UV light, no riboflavin) dissolved in 5.8 ± 0.6 hours. Cross-linked corneas demonstrated increased resistance to dissolution, with a time to dissolution of 17.8 ± 2.6 hours (P < 0.0001). The corneal tissues' resistance to collagenase increased with longer UV-A exposure, reaching a plateau at 30 minutes. Cross-linking both the anterior and posterior corneas did not provide added resistance when compared with cross-linking the anterior corneas only (P > 0.05). γ-irradiated corneas dissolved as readily as deepithelialized controls regardless of whether they were further cross-linked (5.6 ± 1.2 hours) or not (6.1 ± 0.6 hours) (P = 0.43). CONCLUSIONS Collagen cross-linking of the deepithelialized anterior corneal surface for 30 minutes conferred optimal resistance to in vitro keratolysis by collagenase A.
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Moshirfar M, Edmonds JN, Behunin NL, Christiansen SM. Current Options in the Management of Pellucid Marginal Degeneration. J Refract Surg 2014; 30:474-85. [DOI: 10.3928/1081597x-20140429-02] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 03/11/2014] [Indexed: 11/20/2022]
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Akhtar S, Kirat O, Alkatan H, Shu X, Almubrad T. Ultrastructural features of corneas with pellucid marginal degeneration. Microsc Res Tech 2013; 76:404-11. [PMID: 23418051 DOI: 10.1002/jemt.22180] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/22/2012] [Accepted: 01/05/2013] [Indexed: 11/11/2022]
Abstract
PURPOSE Pellucid marginal degeneration (PMD) of the cornea is a rare ectatic disorder which typically affects the inferior or superior peripheral cornea in a crescentic fashion. We report histological and ultrastructural features of three PMD corneas. METHODS The following three patients were diagnosed with PMD corneas: (A) one 41-year-old male, (B) one 56-year-old female, and (C) one 31-year-old male. The patients underwent keratoplasty and the excised corneas were processed for light and electron microscopy to study the ultrastructural features. RESULTS Degenerated corneas were observed in the region adjacent to the limbus. In the degenerated region of the cornea, the Bowman's layer had been replaced by collagenous pannus and the anterior stroma contained degenerated collagen fibrils (CFs) with very large proteoglycans (462±420 nm(2)). The lamellae were fused and keratocytes appeared like fibroblast. The prelimbal region of the PMD cornea had a degenerated Bowman's layer and thin undulating lamellae in the stroma. The CFs of the Bowman's layer and the stroma were replaced by very fine microfilaments. The mean of the minimum CF diameter was 19±3 nm in London Rsin White-embedded tissue. CONCLUSIONS Our observations of the disorganization and degeneration of CFs suggest that PMD could be related to a disorder in the synthesis of CF. This disorder was more severe in the cornea adjacent to the limbus compared to the cornea further away from the limbus.
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Affiliation(s)
- Saeed Akhtar
- Cornea Research Chair, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
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