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Mounir A, Mohamed Mostafa E, Amer I, Abdelgbar AA, Osman HO, Ahmed MA, Ziada H, Ali El Gabbar AG, Hassan MA, Mahmoud A. Corneal densitometry changes after femtosecond laser-assisted intracorneal ring segments implantation in keratoconus. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2024; 13:27-34. [PMID: 38978823 PMCID: PMC11227663 DOI: 10.51329/mehdiophthal1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/23/2024] [Indexed: 07/10/2024]
Abstract
Background Intrastromal corneal ring segments are commonly implanted in the corneas of eyes with mild-to-moderate keratoconus; however, changes in corneal densitometry (CD) after implantation are a matter of debate in the current literature. We evaluated the changes in CD 1 and 3 months after femtosecond laser-assisted Keraring implantation. Methods This retrospective, non-comparative, multicenter, case series study included patients with keratoconus who underwent femtosecond laser-assisted implantation of double segments with 90° and 160° arc lengths or two 160° arc length Keraring segments. Demographic and baseline clinical ophthalmic data were recorded. Corneal topography and tomography data acquired using a Pentacam HR Scheimpflug tomography system (Pentacam High Resolution; Oculus, Wetzlar, Germany) with a best-fit sphere were used as a reference surface. Using the Pentacam HR, CD measurements were acquired over a corneal area of 12 mm in total and at four concentric zones (0-2, 2-6, 6-10, and 10-12 mm) of three corneal stromal depths: 120 μm of the anterior corneal stromal layer, 60 μm of the posterior corneal stromal layer, and the central layer of stroma lying between these two layers. Results We included 40 eyes of 40 patients, including 8 (20%) male and 32 (80%) female individuals, with a mean (standard deviation) age of 21.0 (6.4) years. We observed a significant improvement in the topographic values of steep keratometry (K), flat K, maximum K, and corneal astigmatism (all P < 0.05), but not in the mean K, thinnest corneal pachymetry, corneal thickness at the apex, back elevation, or front elevation (all P > 0.05). The mean total anterior, central, and posterior CD differed significantly among the time points, with a significant increase from the preoperative to the 1-month and 3-month postoperative visits (all P < 0.05) and no difference between those of the 1-month and 3-month postoperative visits (all P > 0.05). The mean CD for the anterior layer in the central, paracentral, and mid-peripheral zones, and the central layer in all four zones, differed significantly among time points, with a significant increase from the preoperative to the 1-month and 3-month postoperative visits (all P < 0.05), which remained unchanged from the 1-month to the 3-month postoperative visit (all P < 0.05), except for the central 2-6-mm zone, which decreased significantly from the 1-month to the 3-month postoperative visit (P < 0.001). The CD of the central 10-12-mm zone did not differ significantly in each pairwise comparison (all P > 0.05). In contrast, CD for the posterior layer in the paracentral zone decreased significantly from the preoperative to the 1-month and 3-month postoperative visits but increased, to a lesser extent, from the 1-month to the 3-month postoperative visit (all P < 0.05). Conclusions Femtosecond laser-assisted Keraring implantation significantly changes CD, with improvement in most topography parameters. Further longitudinal studies with larger sample sizes are required to verify these preliminary findings.
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Affiliation(s)
- Amr Mounir
- Ophthalmology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Engy Mohamed Mostafa
- Ophthalmology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ibrahim Amer
- Ophthalmology Department, Faculty of Medicine, Assiut branch, Al-Azhar University, Assiut, Egypt
| | | | - Hamdy Osman Osman
- Ophthalmology Department, Faculty of Medicine, Assiut branch, Al-Azhar University, Assiut, Egypt
| | | | - Hossam Ziada
- Ophthalmology Department, Faculty of Medicine, Cairo branch, Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Alsadawy Hassan
- Ophthalmology Department, Faculty of Medicine, Cairo branch, Al-Azhar University, Cairo, Egypt
| | - Alaa Mahmoud
- Ophthalmology Department, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
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El-Massry A, Rashid K, Saad S, Osman I. One-Year Outcomes of Intracorneal Ring-Segment Insertion Assisted by Femtosecond Laser Simultaneously Performed with Corneal Collagen Cross-Linking for Treatment of Keratoconus. Clin Ophthalmol 2021; 15:4447-4453. [PMID: 34815661 PMCID: PMC8604634 DOI: 10.2147/opth.s333832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the results of simultaneously performed femtosecond laser–assisted Keraring intrastromal corneal ring–segment insertion and corneal collagen cross-linking for the treatment of keratoconus. Patients and Methods In this retrospective, noncomparative, interventional study, 30 eyes of 24 progressive-keratoconus patients of both sexes aged 18–36 years old with poor best-corrected visual acuity (BCVA) and intolerance to contact lenses were included. All patients had been subjected to complete preoperative and postoperative ophthalmological examinations — unaided VA, BCVA, refraction, Pentacam, and contrast sensitivity examinations at 3-month, 6-month, and 1-year follow-ups. Results Mean unaided VA had changed significantly from 0.649±0.239 logMAR preoperatively to 0.514±0.222 (P=0.014), 0.419±0.162 (P<0.001), and 0.379±0.142 (P<0.001) logMAR at the three follow-up visits, respectively. Mean BCVA had changed significantly from 0.326±0.144 logMAR preoperatively to 0.231±0.140 (P=0.006) at 1-year follow-up. Mean spherical equivalent refraction had decreased significantly at 6-month (P=0.0298) and 1-year follow-up (P=0.0081). Mean steep keratometry (K2) had also significantly reduced from 51.89±3.81 D to 49.87±4.57 D (P=0.034) at 6 months and 49.40±4.39 D (P=0.011) at 1 year. Mean refractive and keratometric astigmatism had significantly decreased at all follow-up visits. Conclusion At 1-year follow-up, keraring intrastromal corneal ring–segment insertion assisted by femtosecond laser performed simultaneously with corneal collagen cross-linking resulted in an improvement in visual, refractive, and topographic outcomes, which may suggest it is an effective treatment of keratoconus.
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Affiliation(s)
- Ahmed El-Massry
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Khalid Rashid
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Seham Saad
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ihab Osman
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
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El-Massry A, Ibrahim O, Abdalla M, Osman I, Mahmoud S. Safety and Indicative Effectiveness of Porcine Corneal Lenticular Implants in Patients with Advanced Keratoconus and Post Lasik Ectasia: A Retrospective Clinical Study. Clin Ophthalmol 2021; 15:3165-3171. [PMID: 34345164 PMCID: PMC8323849 DOI: 10.2147/opth.s325666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to evaluate the safety and feasibility of implanting decellularized porcine corneal lenticules in a femtosecond laser-assisted pocket for patients with advanced keratoconus and post-Lasik ectasia. Methods This is a retrospective clinical study of implanting a porcine corneal lenticular implant in seven eyes: six with advanced keratoconus and clear cornea and one with advanced post-Lasik ectasia with a follow-up for 12 months. The lenticules are extracted from porcine tissue, subjected to a decellularization process, intensely cross-linked, sterilized and packed. They are 7 mm in diameter with at 100–120-micron thickness. The femtosecond laser was used to create an intra-stromal pocket, and then the lenticules were implanted inside the pocket followed by corneal cross-linking 3 months later for six out of seven eyes. Results Five patients had keratoconus (6 eyes) and one patient (one eye) had post-Lasik ectasia. Visual acuity improved in all patients except for one case at 6 and 12 months and this was statistically significant (P=0.002 and 0.007). At one-year follow-up, the mean central corneal thickness increased from 389.43 ± 45.41 to 429.33± 63.20 µm, the maximum keratometry decreased from 64.8 ±5.11 to 62.82± 6.16 D, the mean corneal resistance factor (CRT) increased from 5.67 to 8.42, and the total higher-order aberrations decreased from 1.80 to 1.16. Both changes in the CCT and CRF were statistically significant. One eye had wrinkles and opacified graft, and it was exchanged 3 months postoperatively. Conclusion Porcine corneal lenticules implantation is immunologically safe and well tolerated in patients with advanced keratoconus and post-Lasik ectasia and may be feasible as an alternative to keratoplasty.
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Affiliation(s)
- Ahmed El-Massry
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Osama Ibrahim
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Moones Abdalla
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ihab Osman
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Shahira Mahmoud
- Department of Ophthalmology, Alexandria Faculty of Medicine, Alexandria, Egypt
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Iqbal M, Elmassry A, Mounir A, Ibrahim O, Soliman A. A novel Q-value-based nomogram for single intracorneal ring segment implantation versus standard manufacturer's nomogram combined with accelerated cross-linking for treatment of keratoconus: a randomized controlled trial. Acta Ophthalmol 2021; 99:e501-e511. [PMID: 32930519 PMCID: PMC8359282 DOI: 10.1111/aos.14611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/06/2020] [Indexed: 11/28/2022]
Abstract
Purpose To compare the efficacy of implanting a single Keraring segment according to a novel Q‐value‐based nomogram (QN) to that of segment implantation according to the manufacturer's standard nomogram (SN), for keratoconus treatment. Methods This was a prospective, randomized controlled trial of 104 patients (104 eyes) with Amsler‐Krumeich grade 1 or 2 keratoconus, and type 1 or 2 cone asymmetry determined according to manufacturer's classification. They were randomly distributed into two groups: group A patients (n = 52) underwent Keraring implantation according to the SN, and group B patients (n = 52) underwent implantation of a single (210° arc‐length) Keraring segment according to the QN. Both treatments were combined with accelerated transepithelial cross‐linking, and follow‐up was 6 months. Main outcome measures were preoperative and postoperative visual acuity, subjective refraction and corneal topography. Results At postoperative month 6, group B exhibited statistically significantly higher values of mean uncorrected distance visual acuity (UDVA), sphere, K2, K‐average, K‐max and Q‐anterior (p = 0.02, 0.01, 0.002, 0.001, 0.0001 and 0.03, respectively) compared to that of group A. However, group A exhibited better refractive cylindrical improvements (p = 0.04). In group A, we documented spontaneous extrusion of one Keraring segment. Conclusion Single 210° arc‐length segment implantation using our objective QN was more efficacious for keratoconus treatment than using the subjective SN. The nomograms were comparable when the Q‐anterior value was >−1.00; however, the QN was superior to the SN when the Q‐anterior value was ≤−1.00. The QN yielded greater postoperative UDVA and smoother corneal remodelling than did the SN for treatment of grade 1 and 2 keratoconic eyes.
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Affiliation(s)
- Mohammed Iqbal
- Department of Ophthalmology Faculty of Medicine Sohag University Sohag Egypt
| | - Ahmed Elmassry
- Department of Ophthalmology Faculty of Medicine Alexandria University Alexandria Egypt
| | - Amr Mounir
- Department of Ophthalmology Faculty of Medicine Sohag University Sohag Egypt
| | - Ola Ibrahim
- Department of Ophthalmology Faculty of Medicine Ain Shams University Cairo Egypt
| | - Ashraf Soliman
- Department of Ophthalmology Faculty of Medicine Ain Shams University Cairo Egypt
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Jabbarvand M, Khodaparast M, Jamali A, Ahmadzadeh H, Bordbar S. Changes in the Optical Corneal Densitometry, Visual Acuity, and Refractive Error after the Annular Intracorneal Inlay Implantation. J Curr Ophthalmol 2021; 33:23-30. [PMID: 34084953 PMCID: PMC8102947 DOI: 10.4103/joco.joco_154_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/04/2020] [Accepted: 09/29/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose: To investigate the changes in the optical corneal densitometry as an objective method in assessing the corneal light back-scattering before and 1 year after the annular intracorneal inlay (AICI) implantation into the keratoconic corneas. Methods: Changes in the optical corneal densitometry, visual acuity, refractive, and tomographical status were assessed before and 1 year after the AICI implantation into the corneas with different stages of keratoconus. Optical corneal densitometry was evaluated using the Pentacam-HR in 0–2, 2–6, 6–10, and 10–12 mm rings in the anterior 120 μ, central layers, posterior 60 μ and also the total value were measured for cornea in the Grey Scale Unit criterion. Results: Totally, 34 patients with keratoconus were studied; the uncorrected and best corrected visual acuity were increased after the surgery (0.98 ± 0.25 to 0.53 ± 0.30 logMAR, P < 0.001 and 0.26 ± 0.18 to 0.19 ± 0.14, P = 0.007 logMAR, respectively); the spherical equivalent was decreased from −4.45 ± 2.25 to − 2.06 ± 2.01 D (P = 0.004). AICI implantation led to an increase in the amount of optical corneal densitometry in 0–2 mm central, 2–6 mm central, 6–10 mm central, total central, 2–6 mm posterior, and 2–6 mm total rings (all, P < 0.05); however, a decrease was observed in 0–2 mm anterior ring (P = 0.049). Results of statistical analysis showed that the total optical corneal densitometry, anterior total, and posterior total back-scattering did not change after the AICI implantation (all, P > 0.05). Conclusions: Our results revealed a significant improvement in the visual function, including refractive error and visual acuity following the AICI implantation. Changes in the optical corneal densitometry were different in distinct regions and layers however, the total amount did not change after the AICI implantation.
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Affiliation(s)
- Mahmoud Jabbarvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khodaparast
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Ahmadzadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soodeh Bordbar
- English Department, Iran University of Medical Sciences, Tehran, Iran
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Zaky AG, KhalafAllah MT, Sarhan AE. Combined corneal cross-linking and 320° intrastromal corneal ring segments in progressive keratoconus: one-year results. Graefes Arch Clin Exp Ophthalmol 2020; 258:2441-2447. [PMID: 32651628 DOI: 10.1007/s00417-020-04827-0] [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] [Received: 10/02/2019] [Revised: 05/04/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intrastromal corneal ring segments (ICRS) attain regularization of corneal surface in keratoconus (KC), while collagen cross-linking (CXL) halts or slows its progression. The long-arc 320° rings combined with CXL may have a dual-benefit synergistic effect of surface regularity and progression halt. METHODS This was a prospective case series study including eyes with progressive KC. Femto-assisted 320° ICRS implantation and epi-off CXL 8 weeks later were carried out in all cases. Uncorrected (UCVA) and corrected distance visual acuity (CDVA) were assessed using Snellen's chart, while corneal tomography was evaluated using Scheimpflug imaging. Follow-up was carried out 3, 6, and 12 months after the CXL. RESULTS Thirty-two eyes of 32 patients with progressive KC were included, 18 males and 14 females, and the mean age was 23.1 years. According to the Amsler-Krumeich classification, four eyes had stage 1 KC, 20 had stage 2 KC, and eight had stage 3 KC, and UCVA and CDVA improved from 0.1 ± 0.15 and 0.2 ± 0.19 to 0.4 ± 0.2 (P> 0.01) and 0.5 ± 0.2 (P> 0.01) respectively at 12 months. Manifest refraction spherical equivalent was reduced from - 5.6 ± 2.3 to - 1.1 ± 1.3 D at 12 months after the procedure (P> 0.01). In addition, maximum keratometry was significantly reduced from 54.8 to 49.3 diopters (P> 0.01), while the asphericity index (Q value) has changed from - 1.4 to - 0.25 (P> 0.01) after 12 months. No significant differences were detected between central (n = 12) and eccentric (n = 20) KC in all outcomes. CONCLUSION The 320° ICRS-CXL protocol has improved the visual and the tomographic outcomes at 1 year in our patients with progressive KC. No differences were detected between central and eccentric cases. Further larger studies could ensure the safety profile of the combined protocol.
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Affiliation(s)
- Adel Galal Zaky
- Department of Ophthalmology, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia, Egypt.
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Kim CY, Kim MK. Effect of Sequential Intrastromal Corneal Ring Segment Implantation and Corneal Collagen Crosslinking in Corneal Ectasia. KOREAN JOURNAL OF OPHTHALMOLOGY 2020; 33:528-538. [PMID: 31833250 PMCID: PMC6911792 DOI: 10.3341/kjo.2019.0088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/16/2019] [Accepted: 09/02/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the clinical efficacy of sequential intrastromal corneal ring segment (ICRS) implantation and corneal crosslinking (CXL) in corneal ectasia. Methods This retrospective case series included eight eyes in which both ICRS implantation and CXL had been performed. CXL was performed within 1 month after ICRS implantation. The clinical outcomes (visual acuity, refractive errors, keratometry, and topographic indices) of these patients were compared with those of patients who had undergone only ICRS implantation (eight eyes) or CXL (20 eyes). Results Greater improvement in uncorrected visual acuity was observed in the ICRS + CXL group than in the ICRS or CXL alone groups at both 6 (p = 0.008) and 12 months (p = 0.028). Refractive errors of sphere and spherical equivalent were significantly reduced in both the ICRS (p = 0.002 at 6 months, p = 0.004 at 12 months) and ICRS + CXL groups (p < 0.001 at both 6 and 12 months). Keratometric values including the maximum, minimum, and average were significantly reduced in all 3 groups at postoperative 6 and 12 months; however, the greatest reductions were observed in the ICRS + CXL group (all p < 0.001). Conclusions ICRS implantation followed by CXL within 1 month seems to be effective, and may be superior to ICRS or CXL alone in improving visual acuity and reducing refractive errors and keratometric values.
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Affiliation(s)
- Chung Young Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
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Mounir A, Mostafa EM. Combined accelerated corneal collagen crosslinking and intrastromal Kerarings implantation for treatment of advanced superior keratoconus. GMS OPHTHALMOLOGY CASES 2020; 10:Doc10. [PMID: 32269908 PMCID: PMC7113618 DOI: 10.3205/oc000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose: To report early results of combined accelerated corneal collagen crosslinking (CXL) and intrastromal Kerarings implantation by femtosecond laser in a case of advanced superior keratoconus. Methods: The patient was a 27-year-old male with left eye grade 3 keratoconus with superior cone. He was diagnosed by Sirius Scheimpflug corneal topography (CSO, Florence, Italy). The right eye had previously been subjected to penetrating keratoplasty. The uncorrected visual acuity (UCVA) in the right eye (RE) was 1.2 LogMAR, best corrected visual acuity (BCVA) was 0.8 by a refraction of –7.50Ds –3.00Dc @12. The UCVA in the left eye (LE) was 1.2 LogMAR, BCVA was 0.9 by a refraction of –8.50 Ds –5.50Dc @169. Intrastromal Kerarings implantation by femtosecond laser was carried out by IntraLase (iFS, Abbott) along with accelerated transepithelial corneal collagen crosslinking by KXL system (Avedro, USA) in the same session. Follow-up was done for a period of 12 months after surgery. Results: The patient was followed up for 12 months with improvement of visual acuity as regards UCVA and BCVA and improvement of corneal topographic parameters including keratometry and front and back elevations. Conclusion: Combined accelerated corneal collagen crosslinking and intrastromal Kerarings implantation by femtosecond laser is an effective method in the treatment of this uncommon type of keratoconus.
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Affiliation(s)
- Amr Mounir
- Sohag Faculty of Medicine, Ophthalmology Department, Sohag University, Sohag, Egypt
| | - Engy Mohamed Mostafa
- Sohag Faculty of Medicine, Ophthalmology Department, Sohag University, Sohag, Egypt
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Fariselli C, Vega-Estrada A, Arnalich-Montiel F, Alio JL. Artificial neural network to guide intracorneal ring segments implantation for keratoconus treatment: a pilot study. EYE AND VISION 2020; 7:20. [PMID: 32292796 PMCID: PMC7144046 DOI: 10.1186/s40662-020-00184-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/10/2020] [Indexed: 02/01/2023]
Abstract
Background To analyze the clinical results of an artificial neural network (ANN) that has been processed in order to improve the predictability of intracorneal ring segments (ICRS) implantation in keratoconus. Methods This retrospective, comparative, nonrandomized, pilot, clinical study included a cohort of 20 keratoconic eyes implanted with intracorneal ring segments KeraRing (Mediphacos, Belo Horizonte, Brazil) using the ANN (ANN group) and 20 keratoconic eyes implanted with KeraRing using the manufacturer’s nomograms (nomogram group). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) (visual acuity is expressed in decimal value and in LogMAR value in brackets), manifest refraction, corneal topography, tomography, aberrometry, pachymetry and volume analysis (Sirius System. CSO, Firenze, Italy) were performed during the preoperative visit; and the two groups, ANN group and nomogram group, did not differ significantly preoperatively in all of the parameters evaluated. These preoperative values were compared with the results obtained at the third-month visit. Mann-Whitney test and Wilcoxon test were used for the statistical analyses. Results The spherical equivalent and the keratometric values decreased significantly in both groups. The CDVA improved from 0.60 ± 0.23 (0.22 LogMAR) pre-operatively to 0.73 ± 0.21 (0.14 LogMAR) post-operatively in the ANN group (p < 0.005), and from 0.54 ± 0.19 (0.27 LogMAR) pre-operatively to 0.62 ± 0.19 (0.21 LogMAR) post-operatively in the nomogram group (p < 0.01), with statistically significant difference between the two groups (p < 0.05), being better in the ANN group. Coma-like aberrations decreased significantly in the ANN group, while in the nomogram group they did not change significantly, but no statistically significant difference was found between the two groups. Conclusions ANN to guide ICRS provides an increase in the visual acuity, reduction in the spherical equivalent and improvement in the optical quality of keratoconus patients. ANN gives better results when compared with the manufacturer’s nomograms in terms of better corrected vision and reduction of the coma-like aberrations. The constant inclusion of new cases will make the predictability of ANN increasingly better as the software finetunes its learning.
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Affiliation(s)
- Chiara Fariselli
- 1Research and Development Department, Vissum, Calle Cabañal, 1. Edificio Vissum, 03016 Alicante, Spain.,2Department of Experimental, Diagnostic, and Specialty Medicine (DIMES), Ophthalmology Service, St. Orsola-Malpighi Teaching Hospital, University of Bologna, Bologna, Italy
| | - Alfredo Vega-Estrada
- 1Research and Development Department, Vissum, Calle Cabañal, 1. Edificio Vissum, 03016 Alicante, Spain.,3Cornea and Refractive Surgery Department, Vissum, Alicante, Spain.,4Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | | | - Jorge L Alio
- 1Research and Development Department, Vissum, Calle Cabañal, 1. Edificio Vissum, 03016 Alicante, Spain.,3Cornea and Refractive Surgery Department, Vissum, Alicante, Spain.,4Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Evaluation of a Tangential Map-Based Nomogram for Intrastromal Corneal Ring Segments' Implantation in Keratoconus: One Year Results. J Ophthalmol 2020; 2020:3983508. [PMID: 32148940 PMCID: PMC7049859 DOI: 10.1155/2020/3983508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/27/2019] [Accepted: 12/30/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate a new tangential map-based nomogram versus the axial map-based nomogram for ICRS in keratoconus. Methods A prospective case series study including 64 eyes of 64 patients who underwent ICRS implantation. Cone location was determined for each eye with two maps: the axial and the tangential. Appropriate ring selection was determined using two surgical nomograms: axial map-based and tangential map-based. Visual, refractive, and topographic outcomes were assessed before, as well as at 3, 6, and 12 months after ICRS implantation. Results The cone location, and consequently the ring selection, was significantly different in the two nomograms with a “centralization tendency” in the tangential map. In the axial group, UDVA and CDVA improved from 0.12 ± 0.04 and 0.24 ± 0.08 to 0.28 ± 0.08 and 0.4 ± 0.1, respectively. Similarly, MRSE substantially decreased from −6.7 ± 3.3 to −1.2 ± 1.1D at 12 months after the procedure. In the tangential group, UDVA and CDVA improved from 0.09 ± 0.06 and 0.2 ± 0.1 to 0.5 ± 0.2 and 0.7 ± 0.2, respectively. MRSE substantially decreased from −4.9 ± 1D at 12 months after the procedure. In the tangential group, UDVA and CDVA improved from 0.09 ± 0.06 and 0.2 ± 0.1 to 0.5 ± 0.2 and 0.7 ± 0.2, respectively. MRSE substantially decreased from −4.9 ± 1D at 12 months after the procedure. In the tangential group, UDVA and CDVA improved from 0.09 ± 0.06 and 0.2 ± 0.1 to 0.5 ± 0.2 and 0.7 ± 0.2, respectively. MRSE substantially decreased from −4.9 ± 1P=0.01∗. Similarly, the gain in the CDVA was 0.4 and 0.15 in the tangential and axial groups, respectively, at 12 months, P=0.01∗. Similarly, the gain in the CDVA was 0.4 and 0.15 in the tangential and axial groups, respectively, at 12 months, Conclusion The tangential map-based nomogram attained better visual and refractive outcomes at 1 year. In addition, the cone location was significantly different between both maps with a centralization tendency in the tangential one.
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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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Three-Year Outcomes of Cross-Linking PLUS (Combined Cross-Linking with Femtosecond Laser Intracorneal Ring Segments Implantation) for Management of Keratoconus. J Ophthalmol 2018; 2018:6907573. [PMID: 29576880 PMCID: PMC5822772 DOI: 10.1155/2018/6907573] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/11/2017] [Accepted: 11/12/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To analyze the results of three-year outcomes of combined epithelium-on cross-linking with femtosecond laser ICRS (cross-linking PLUS) for keratoconus management. Design A retrospective multicenter clinical study. Methods 43 eyes of 38 patients were subjected to preoperative and postoperative UCVA, BCVA, refraction, Pentacam pachymetry, and keratometry examinations at 3-, 6-, 12-, 24-, and 36-month follow-up period. Results The preoperative and postoperative mean UCVA was 1.30 ± 0.48 (logMAR ± SD) and 0.82 ± 0.22 respectively. The preoperative and postoperative mean BCVA was 0.90 ± 0.40 and 0.60 ± 0.30, respectively. The preoperative and postoperative mean K average was 50.63 ± 0.87 (D ± SD) and 45.56 ± 0.98, respectively. The preoperative and postoperative mean pachymetry was 471 ± 92.36 (μm ± SD) and 423 ± 39.58, respectively. The preoperative and postoperative mean astigmatism was 7.55 ± 1.75 and 3.39 ± 1.26, respectively. One eye showed ICRS edge exposure while 6 eyes showed progression of keratoconus. Conclusion CXL PLUS was proved to be a successful procedure to halt progression (mainly by CXL) and to correct the refractive status of the keratoconic eye (mainly by ICRS). CXL PLUS performed a synergistic action correcting and maintaining the correction of both myopic and astigmatic components of keratoconus.
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