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Mechleb N, Gatinel D, Saad A. A Technique of Multiple Corneal Allogeneic Ring Segments Prepared from a Single Corneal Graft: A Case Series. Cornea 2024:00003226-990000000-00599. [PMID: 38950064 DOI: 10.1097/ico.0000000000003604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/19/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE To describe a novel technique for preparing multiple corneal allogeneic ring segments (CAIRS) from a single corneal graft using femtosecond laser technology. METHODS This is a case series of 10 eyes from 10 patients with keratoconus who underwent FS-assisted CAIRS implantation using corneas from 4 donors at the Hospital Foundation Adolphe de Rothschild-Noémie de Rothschild institute. A preoperative and postoperative examination was performed at 1 day, 1 week, and 1 month. Anterior segment OCT and corneal tomography with aberrometric and pachymetric analyses were performed at each visit. Visual, refractive, and topographic parameters were extracted. The thickness and width of implanted CAIRS were analyzed. RESULTS Patients were classified according to keratoconus severity: group A (maximal keratometry Kmax <75D) and group B (Kmax >75D). At 1 month postoperatively, both groups A and B showed a significant decrease in mean keratometry by 4.78 ± 1.57D and 12.87 ± 4.62D, respectively. Total and higher order aberrations decreased by 5.66 ± 4.55 and 0.65 ± 1.54 in group A and by 9.45 ± 9.15 and 0.49 ± 1.39 in group B, respectively. The corrected distance visual acuity improved by 4.8 ± 1.7 lines in group A. Visual improvement was not significant in group B. One eye in group B exhibited acute rejection and required explantation. CONCLUSIONS FS-assisted multiple CAIRS implantation using a single corneal graft maximizes the utilization of viable corneal tissue. CAIRS implantation is an effective and biocompatible therapeutic alternative, particularly in cases of moderate to advanced keratoconus with Kmax <75D.
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Affiliation(s)
- Nicole Mechleb
- Hospital Foundation Adolphe De Rothschild, Paris, France; and
- Center of Expertise and Research in Visual Optics, Paris, France
| | - Damien Gatinel
- Hospital Foundation Adolphe De Rothschild, Paris, France; and
- Center of Expertise and Research in Visual Optics, Paris, France
| | - Alain Saad
- Hospital Foundation Adolphe De Rothschild, Paris, France; and
- Center of Expertise and Research in Visual Optics, Paris, France
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Kirgiz A, Kemer Atik B, Emul M, Taskapili M. Clinical outcomes of femtosecond laser-assisted corneal allogenic intrastromal ring segment (CAIRS) in the treatment of keratoconus. Clin Exp Ophthalmol 2024. [PMID: 38938058 DOI: 10.1111/ceo.14411] [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: 11/21/2023] [Revised: 05/12/2024] [Accepted: 06/02/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND To evaluate the results of corneal allogenic intrastromal ring segment (CAIRS) implantation in keratoconus. METHODS The medical records of patients with keratoconus who underwent CAIRS implantation were reviewed. The CAIRS, prepared by trephination from the donor cornea, was implanted into a tunnel created using the femtosecond laser. The depth of the tunnel was 200 μ; the inner diameter of the tunnel was 4.5 mm; and the outer diameter was 7 mm. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry, minimum corneal thickness (CT), endothelial cell density (ECD), and high order aberration values were recorded preoperatively and at the 1st, 3rd, and 6th months postoperatively. RESULTS A total of 23 eyes of 23 patients were included in the study. Preoperative UCVA (0.08 ± 0.01) and BCVA (0.25 ± 0. 11) values improved postoperatively and reached 0.40 ± 0.05 and 0.68 ± 0.09, respectively, at the end of the 6-month follow-up period (p1 < 0.001, p2 = 0.016; respectively). A statistically significant flattening of all keratometric values was observed in the postoperative period compared to preoperatively (p < 0.001 for all). There were no statistical differences between CT and ECC values at the preoperative and postoperative visits (p1 = 0.654, p2 = 0.769; respectively). In addition, coma aberration values were lower than the preoperative values at all postoperative visits (p < 0.05 for all). CONCLUSIONS These results suggest that CAIRS implantation is a safe treatment option with good visual and keratometric outcomes for suitable patients with keratoconus.
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Affiliation(s)
- Ahmet Kirgiz
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burcu Kemer Atik
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Emul
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Muhittin Taskapili
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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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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Bteich Y, Assaf JF, Gendy JE, Müller F, Jacob S, Hafezi F, Awwad ST. Asymmetric All-Femtosecond Laser-Cut Corneal Allogenic Intrastromal Ring Segments. J Refract Surg 2023; 39:856-862. [PMID: 38063823 DOI: 10.3928/1081597x-20231018-04] [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: 12/18/2023]
Abstract
PURPOSE To describe a novel technique for cutting asymmetric allogenic segments using the femtosecond laser for the management of cases of keratoconus with non-coinciding astigmatism and coma axes. METHODS Four eyes of 2 patients with irregular keratoconus and asymmetric allogenic segments were included. Visual, refractive, tomographic, and aberrometric outcomes, and optical coherence tomography (OCT) sections were measured preoperatively and 6 months postoperatively. Evaluations included slit-lamp examination, manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, and simulated and maximum anterior keratometry (Kmax) using anterior segment OCT. RESULTS Spherical and cylindrical refractive errors decreased from -2.38 ± 2.96 and -2.94 ± 2.16 to -1.81 ± 2.77 (P = .04) and -1.75 ± 2.07 (P = .01) diopters (D), respectively, 6 months postoperatively. There was an average gain of three lines of CDVA. Kmax decreased from 50.02 ± 1.99 to 47.89 ± 3.05 D (P= .03) and coma from 1.05 ± 0.21 to 0.21 ± 0.19 D (P = .01). CONCLUSIONS Asymmetric femtosecond laser-cut allogenic segments allow a higher level of customization based on size, shape, and arc length, in contrast to the limited range of available synthetic asymmetrical segments. [J Refract Surg. 2023;39(12):856-862.].
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Nacaroglu SA, Yesilkaya EC, Perk FFNK, Tanriverdi C, Taneri S, Kilic A. Efficacy and safety of intracorneal allogenic ring segment implantation in keratoconus: 1-year results. Eye (Lond) 2023; 37:3807-3812. [PMID: 37328510 PMCID: PMC10698022 DOI: 10.1038/s41433-023-02618-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of corneal allogenic intrastromal ring segments in the management of keratoconus patients. METHODS The retrospective, nonrandomized, interventional case series consisted of 65 keratoconic eyes of 49 consecutive patients who had ring segment-shaped corneal allografts (KeraNatural®) implanted in intrastromal tunnels created using a femtosecond laser. The main outcome measures were uncorrected visual acuity (UCVA), corrected distant visual acuity (CDVA), refraction, keratometry, and pachymetry. Computed tomography scans of the corneal surfaces were also performed preoperatively as well as 3, 6 and 12 months postoperatively. RESULTS Mean age was 29.5 ± 7.3 years (median 29, range: 20-52 years). The mean UCVA improved from 0.91 ± 0.50 logMAR preoperatively to 0.40 ± 0.24 logMAR postoperatively at 6 month follow-up (p < 0.01) and the mean CDVA improved from 0.87 ± 0.20 logMAR preoperatively to 0.27 ± 0.06 logMAR postoperatively (p < 0.01). The mean spherical equivalent improved from -8.82 ± 4.57 to -3.45 ± 4.81D (p < 0.01). Average Keratometry decreased from 49.23 ± 5.22 preoperatively to 45.63 ± 4.89 D postoperatively (p < 0.01). Mean anterior and posterior maximum elevation were also decreased significantly (p < 0.01). In one patient, dislocation of the graft towards the tunnel incision site and dehiscense at the tunnel entrance were observed in the first week of the operation. Yellow-white deposits were observed in the segment tunnels in five cases after 6 months. CONCLUSION This study demonstrated that implantation of corneal allograft ring segments is a viable alternative treatment for keratoconus with safety and good visual results.
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Affiliation(s)
- Senay Asik Nacaroglu
- Faculty of Medicine, Ophthalmology Department, Istanbul Medipol University, Istanbul, Turkey.
| | - Elif Ceren Yesilkaya
- Şişli Hamidiye Etfal Training and Research Hospital, Department of Ophthalmology, University of Health Sciences, Istanbul, Turkey
| | | | - Cafer Tanriverdi
- Faculty of Medicine, Ophthalmology Department, Istanbul Medipol University, Istanbul, Turkey
| | - Suphi Taneri
- Ophthalmology Department, Augenzentrum am St. Franziskus Hospital, Munster, Germany
| | - Aylin Kilic
- Faculty of Medicine, Ophthalmology Department, Istanbul Medipol University, Istanbul, Turkey
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Awwad ST, Jacob S, Assaf JF, Bteich Y. Extended Dehydration of Corneal Allogenic Intrastromal Ring Segments to Facilitate Insertion: The Corneal Jerky Technique. Cornea 2023; 42:1461-1464. [PMID: 37399565 DOI: 10.1097/ico.0000000000003328] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/21/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE The aim of this study was to describe a new technique to facilitate the insertion of corneal allogenic intrastromal ring segments. METHODS A single-segment corneal allogenic intrastromal ring segment (CAIRS) was trephined from donor corneas and allowed to markedly dehydrate for 75 minutes before the start of the procedure with a room humidity of 35% to 45%. The duration of the insertion step and the intrastromal segment size at 1 week as measured by optical coherence tomography were compared with previously performed single-segment CAIRS procedures using the conventional technique. RESULTS A total of 41 eyes of 36 patients underwent 1-segment CAIRS insertion of the same trephination size (750 µm). Fifteen eyes underwent the conventional insertion procedure, and 26 eyes had a dehydrated segment inserted. The time taken to insert the CAIRS analyzed by surgical video recording starting after the femtosecond tunnel creation and initiation of the insertion to the segment ironing step was 282 ± 103 and 97 ± 23 seconds for the conventional and the dehydrated segment technique, respectively ( P < 0.001). Anterior segment optical coherence tomography performed 1 week postoperatively revealed similar segment thickness and width of 471.3 ± 54.1 μm and 1285.1 ± 191.0 μm for the conventional allogenic segments and 483.4 ± 58.3 μm and 1227.2 ± 165.2 μm for the dehydrated segments ( P = 0.515 and 0.314, respectively). CONCLUSIONS Markedly dehydrated corneal allogenic segments are easier and faster to insert than the nondehydrated ones while maintaining similar sizes intrastromally. This dehydration technique makes the procedure similar to the one with synthetic segments and hence reduces the learning curve.
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Affiliation(s)
- Shady T Awwad
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Jad F Assaf
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Bteich
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
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Bteich Y, Assaf JF, Mrad AA, Jacob S, Hafezi F, Awwad ST. Corneal Allogenic Intrastromal Ring Segments (CAIRS) for Corneal Ectasia: A Comprehensive Segmental Tomography Evaluation. J Refract Surg 2023; 39:767-776. [PMID: 37937759 DOI: 10.3928/1081597x-20231011-01] [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: 11/09/2023]
Abstract
PURPOSE To evaluate the visual, refractive, and tomographic results of patients with corneal ectasia treated with corneal allogenic intrastromal ring segments (CAIRS) insertion without concomitant corneal cross-linking. METHODS Fifty-two eyes from 39 patients with stable corneal ectasia and unsatisfactory visual acuity with contact lenses were included. All patients underwent CAIRS insertion with no concomitant corneal procedure at the American University of Beirut Medical Center between September 2019 and July 2022. Visual, refractive, topographic, aberrometric, epithelial, stromal, and segment thickness data were measured relative to baseline at 1 week, 1 month, and at least 3 months postoperatively. Evaluations included slit-lamp examination, manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity, and tomography using anterior segment optical coherence tomography. RESULTS Mean follow-up time was 6.9 ± 5.2 months. UDVA and CDVA improved from 0.97 ± 0.47 and 0.56 ± 0.19 preoperatively to 0.52 ± 0.21 (P < .001) and 0.23 ± 0.19 (P < .001) 3 months postoperatively. Manifest refraction spherical equivalent and cylinder improved from -6.71 ± 6.51 and -4.02 ± 2.24 diopters (D) preoperatively to -3.78 ± 4.07 D (P < .001) and -2.35 ± 1.98 D (P < .001) 3 months postoperatively, respectively. Maximum anterior keratometry and vertical coma decreased from 58.09 ± 7.92 D and 1.56 ± 1.09 µm to 52.48 ± 6.69 D (P < .001) and 0.43 ± 0.77 µm, respectively (P < .001). Corneal epithelium thickened proximal to the allogenic segment by 7.25 µm (P < .001), whereas stromal elevation at the cone decreased from 38.61 ± 18.5 to 23.82 ± 13.4 µm, respectively (P < .001). No major complications were observed and only 1 eye lost one line of CDVA. CONCLUSIONS Treatment of corneal ectasia with CAIRS improved visual, refractive, topographic, and tomographic parameters. Epithelial thickening central to CAIRS, along with anterior stromal flattening is postulated to contribute to tomographic flattening and regularization. [J Refract Surg. 2023;39(11):767-776.].
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De Clerck EEB, Bravetti GE, Kropp M, Massa H, Pajic B, Thumann G, Guber I. Bowman Layer Transplantation for Treating Keratoconus-Preliminary Findings. J Clin Med 2023; 12:jcm12062402. [PMID: 36983402 PMCID: PMC10055818 DOI: 10.3390/jcm12062402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Mid-stromal isolated Bowman layer transplantation aims to reduce and stabilize corneal ectasia in patients with advanced, progressive keratoconus. The purpose of this review is to evaluate the effectiveness and safety of this new surgical technique. (2) Methods: Following the PRISMA statement and checklist, we searched Medline, the Cochrane Controlled Trials Register, and Embase and used a broad systematic search strategy according to the Cochrane Collaboration. (3) Results: Eight studies with a total number of 120 eyes of 106 patients met our inclusion criteria. One month after Bowman layer transplantation, patients with keratoconus showed a significant decrease in the measured simulated keratometry (-4.74 D [95% CI -6.79 to -2.69]) and the maximum keratometry (-7.41 D [95% CI -9.64 to -5.19]), which remained significant one year postoperatively (-2.91 D [95% CI -5.29 to -0.53] and -5.80 D [-8.49 to -3.12]). Intra- and postoperative complications were observed in 3% and 9% of the patients, respectively. An estimated success rate of 75% to 85% was achieved by experienced surgeons at 5 to 8 years postoperatively. (4) Conclusions: Bowman layer transplantation may be an effective and safe treatment option in patients with advanced, progressive keratoconus. Additional multicenter prospective interventional studies are needed to confirm these preliminary findings.
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Affiliation(s)
- Eline Elodie Barbara De Clerck
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Giorgio Enrico Bravetti
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Martina Kropp
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Horace Massa
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Bojan Pajic
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Eye Clinic ORASIS, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
- Faculty of Sciences, Department of Physics, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Gabriele Thumann
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Ivo Guber
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
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