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D'Oria F, Bagaglia SA, Alio Del Barrio JL, Alessio G, Alio JL, Mazzotta C. Refractive surgical correction and treatment of keratoconus. Surv Ophthalmol 2024; 69:122-139. [PMID: 37774800 DOI: 10.1016/j.survophthal.2023.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
Keratoconus is an ectatic corneal disorder that causes severe vision loss. Surgical options allow us to correct, partially or totally, the induced refractive error. Intracorneal ring segments (ICRS) implantation represents a minimally invasive surgical option that improves visual acuity, with a high success rate and a low overall complication rate. Corneal allogenic ICRS consists of ring segments derived from allogenic eye bank-processed donor corneas. Selective topography-guided transepithelial photorefractive or phototherapeutic keratectomy combined with CXL is another way in selected cases to improve spectacles corrected distance visual acuity. The microphotoablative remodeling of the central corneal profile is generally planned by optimizing the optical zones and minimizing tissue consumption. Phakic intraocular lens (PIOL) implant is considered in patients with stable disease and acceptable anatomical requirements. The two types of pIOLs, depending on their implantation inside the eye, are anterior chamber-pIOLs, which fixate to the anterior surface of the iris by using a polymethomethacrolate claw at the two haptics, and posterior chamber-pIOLs. In patients with both cataracts and keratoconus, the correct IOL power is difficult to obtain due to the irregular corneal shape and K values. Toric IOL is recommended, but carefully judging the topography and the possible need of subsequent keratoplasties.
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Affiliation(s)
- Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
| | - Simone A Bagaglia
- Departmental Ophthalmology Unit, Sant' Andrea Hospital, USL Toscana Sud-Est, Massa Marittima, Italy
| | - Jorge L Alio Del Barrio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Jorge L Alio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
| | - Cosimo Mazzotta
- Departmental Ophthalmology Unit, AUSL Toscana Sud Est, Campostaggia, Siena, Italy; Department of Medicine, Surgery and Neurosciences, Postgraduate Ophthalmology School, Siena University, Siena, Italy; Siena Crosslinking Center, Siena, Italy
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2
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Sim HW, Lee WY, Lee R, Yang SY, Ham YK, Lim SD, Park HJ. The Anti-Inflammatory Effects of Broccoli ( Brassica oleracea L. var. italica) Sprout Extract in RAW 264.7 Macrophages and a Lipopolysaccharide-Induced Liver Injury Model. Curr Issues Mol Biol 2023; 45:9117-9131. [PMID: 37998749 PMCID: PMC10670196 DOI: 10.3390/cimb45110572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
Brassica oleracea var. italica (broccoli), a member of the cabbage family, is abundant with many nutrients, including vitamins, potassium, fiber, minerals, and phytochemicals. Consequently, it has been used as a functional food additive to reduce oxidative stress and inflammatory responses. In the current study, the effects of sulforaphane-rich broccoli sprout extract (BSE) on the inflammatory response were investigated in vitro and in vivo. Comparative high-performance liquid chromatography analysis of sulforaphane content from different extracts revealed that 70% ethanolic BSE contained more sulforaphane than the other extracts. qPCR and enzyme immunoassay analyses revealed that BSE markedly reduced the expression of proinflammatory cytokines and mediators, including cyclooxygenase 2, interleukin (IL)-1β, IL-6, IL-1, inducible nitric oxide synthase (iNOS), and tumor necrosis factor-α (TNF-α), in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells. Pretreatment with BSE improved the survival rate and suppressed alanine aminotransferase and aspartate aminotransferase expression in LPS-induced endotoxemic mice, while proinflammatory cytokines such as IL-1β, TNF-α, IL-6, cyclooxygenase-2, and iNOS decreased dramatically in the LPS-induced liver injury model via BSE treatment. Additionally, F4/80 immunostaining showed that BSE suppressed hepatic macrophage infiltration in the liver after lipopolysaccharide injection. In conclusion, BSE may be a potential nutraceutical for preventing and regulating excessive immune responses in inflammatory disease.
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Affiliation(s)
- Hyeon Woo Sim
- Department of Animal Biotechnology, College of Life Science, Sangji University, Wonju-si 26339, Republic of Korea; (H.W.S.)
| | - Won-Yong Lee
- Department of Livestock, Korea National College of Agriculture and Fisheries, Jeonju-si 54874, Republic of Korea;
| | - Ran Lee
- Department of Animal Biotechnology, College of Life Science, Sangji University, Wonju-si 26339, Republic of Korea; (H.W.S.)
| | - Seo Young Yang
- Department of Biology Education, Teachers College and Institute for Phylogenomics and Evolution, Kyungpook National University, Daegu 41566, Republic of Korea;
| | - Youn-Kyung Ham
- Department of Animal Science, Sangji University, Wonju-si 26339, Republic of Korea;
| | - Sung Don Lim
- Department of Plant Life and Resource Science, Sangji University, Wonju-si 26339, Republic of Korea
| | - Hyun-Jung Park
- Department of Animal Biotechnology, College of Life Science, Sangji University, Wonju-si 26339, Republic of Korea; (H.W.S.)
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Fard AM, Patel SP, Nader ND. The efficacy of 2 different phakic intraocular lens implant in keratoconus as an isolated procedure or combined with collagen crosslinking and intra-stromal corneal ring segments: a systematic review and meta-analysis. Int Ophthalmol 2023; 43:4383-4393. [PMID: 37470861 DOI: 10.1007/s10792-023-02813-z] [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: 07/31/2022] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE To compare the efficacy of phakic intra-ocular lenses in isolation or in combination with corneal crosslinking (CXL) and/or intra-stromal corneal ring segments (ICRS) in keratoconus. METHODS Data extracted from the publications meeting the selection. The outcome parameters included mean pre- and post-operative uncorrected distance visual acuity, corrected distance visual acuity (CDVA), sphere and cylinder of refraction and complications. Available data analyzed with Cochrane Review Manager. RESULTS A total of 23 studies including 464 eyes were included. All the parameters showed significant improvement in all subgroups other than CDVA in ACPIOL + CXL subgroup and cylinder in PIOL + CXL subgroups. There was not a significant difference between PCPIOL and ACPIOL in the outcomes, exception was more improvement of CDVA in "ACPIOL only" than" PCPIOL only" subgroup. CONCLUSION Both PCPIOLs and ACPIOLs are comparably safe and efficient options in management of KCN and their efficacy significantly improves when combined with CXL/ICRS.
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Affiliation(s)
- Ali Mahdavi Fard
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Ophthalmology, Doheny Eye Center of UCLA, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sangita P Patel
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- Research and Ophthalmology Services, Veterans Administration of Western New York Healthcare System, Buffalo, NY, USA
| | - Nader D Nader
- Department of Anesthesiology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY, USA.
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Pinto C, Monteiro T, Franqueira N, Faria-Correia F, Mendes J, Vaz F. Posterior chamber collamer phakic intraocular lens implantation: Comparison of efficacy and safety for low and moderate-to-high myopia. Eur J Ophthalmol 2021; 32:11206721211012861. [PMID: 33887990 DOI: 10.1177/11206721211012861] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare visual, refractive and safety outcomes of central-hole posterior chamber collamer phakic intraocular lens implantation for low and moderate-to-high myopia. SUBJECTS/METHODS This retrospective cohort study included 338 eyes submitted to posterior chamber collamer phakic intraocular lens implantation that completed a 12-month postoperative follow-up. Two groups were defined depending on preoperative spherical equivalent: group 1 comprised 106 eyes with manifest spherical equivalent of -6.00 D or less; group 2 comprised 232 eyes with manifest spherical equivalent higher than -6.00 D. Effectiveness, predictability, stability and safety outcomes were compared preoperatively and at 1, 6 and 12 months postoperatively. RESULTS At 1-year postoperative, uncorrected and corrected visual acuities were 0.02 ± 0.17 and -0.01 ± 0.12 logMAR (group 1) and 0.04 ± 0.20 and 0.01 ± 0.16 logMAR (group 2), with an efficacy index of 1.05 ± 0.17 and 1.17 ± 0.28. Respectively, 92 (86.8%) and 199 (85.8%) eyes were within ±0.50 D of targeted refraction, and postoperative manifest refraction changes were -0.07 ± 0.25 D and -0.07 ± 0.35 D. Intraocular pressure did not change significantly. The mean rate of endothelial cell loss was 1.12% and 1.10%, respectively. One case of anterior subcapsular cataract (group 2) was observed. ICL exchange occurred in one case (group 1) and three cases (group 2). No vision-threatening complications were reported. CONCLUSION The posterior chamber collamer phakic intraocular lens implantation demonstrated high visual and refractive efficacy with an excellent safety profile for the correction of both low and moderate-to-high myopia, revealing equivalent 1-year outcomes regardless of the degree of preoperative myopia.
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Affiliation(s)
| | - Tiago Monteiro
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Nuno Franqueira
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
| | - Fernando Faria-Correia
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - José Mendes
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
- Life and Health Sciences Research Institute (ICVS), Escola de Medicina, Universidade do Minho, Braga, Portugal
| | - Fernando Vaz
- Department of Ophthalmology, Hospital de Braga, Braga, Portugal
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Toric intraocular lens power calculation in cataract patients with keratoconus. J Cataract Refract Surg 2021; 47:1389-1397. [PMID: 33770295 DOI: 10.1097/j.jcrs.0000000000000638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022]
Abstract
Purpose Intra-ocular lens (IOL) power calculation in eyes with keratoconus typically results in hyperopic postoperative refractive error. We investigated the visual and refractive outcomes in keratoconus patients having cataract surgery with a toric IOL and compared IOL power calculation accuracy of conventional formulae and keratoconus specific formulae. Setting Ein-Tal Eye Center, Tel-Aviv, Israel. Design Retrospective case-series study. Methods Post-operative visual acuity and manifest refraction were examined. The error in predicted refraction and IOL power calculation accuracy within a range of 0.5 to 2.0 diopters were compared between different IOL calculating formulae. Results Thirty-two eyes with keratoconus were included. Visual acuity improved in all cases and subjective astigmatism decreased from -2.95+/-2.10 D to -0.95+/-0.80 D (p<0.001). Mean absolute errors were: Barrett True-K for keratoconus with measured or predicted posterior corneal power, 0.34 D; Barrett Universal II, 0.64 D; Kane Formula, 0.69 D; Kane Formula for keratoconus, 0.49 D; SRK/T, 0.56 D; Haigis, 0.72 D; Holladay 1, 0.71 D and Hoffer Q, 0.87 D. Barrett True-K formula with measured posterior corneal power, SRK/T and Kane Formula for keratoconus resulted in a prediction error within 0.5 D of 87.5%, 59.4% and 53.1%, respectively. Conclusions Cataract removal with a toric IOL significantly improves visual acuity and decreases astigmatism in keratoconic eyes with a topographic central relatively regular astigmatic component. Keratoconus specific formulae resulted in lower mean error in predicted refraction compared with conventional calculating formulae. Utilizing the posterior corneal power within the Barrett True K formula for keratoconus improved IOL power prediction accuracy.
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McLintock CA, McKelvie J, Miraflores Gomez S, Gatzioufas Z, Elalfy M, Hamada S. Outcomes of sequential intracorneal ring segment and phakic intraocular lens insertion for visual rehabilitation in keratoconus. Eur J Ophthalmol 2020; 31:2219-2226. [PMID: 33135490 DOI: 10.1177/1120672120969600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report the visual and refractive outcomes of sequential intracorneal ring segment (ICRS) and toric phakic intraocular lens (IOL) insertion for visual rehabilitation in keratoconus. METHODS A retrospective interventional cohort study was performed through the Corneoplastics unit and Eye Bank, Queen Victoria Hospital, East Grinstead, United Kingdom. RESULTS 14 eyes of 12 patients had sequential ICRS and phakic IOL implantation for visual rehabilitation of keratoconus between June 2014 and February 2018. After at least 6 months follow-up, the number of eyes with an uncorrected distance visual acuity (UDVA) of 20/40 UDVA or better increased from zero (0%) to 10 (71%). 12 (85.7%) eyes achieved a post-operative UDVA equal to or better than the pre-operative corrected distance visual acuity (CDVA). The number percentage of eyes with a CDVA of 20/40 or better increased from 3 (31%) to 14 (100%). The mean final spherical equivalent improved from -4.07 to -0.17 (p ⩽ 0.001). The mean refractive astigmatism magnitude improved from 4.76D to 1.23D (p = 0.002). Seven (50%) eyes had 1.0D or less of refractive astigmatism post-operatively. CONCLUSION In this cohort of eyes with keratoconus, sequential ICRS and phakic IOL implantation resulted in excellent visual and refractive outcomes after at least 6 months.
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Affiliation(s)
- Cameron A McLintock
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK.,Department of Ophthalmology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - James McKelvie
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK.,Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Zisis Gatzioufas
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK.,Department of Ophthalmology, University Hospital Basel, Basel, BS, Switzerland
| | - Mohamed Elalfy
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK.,Cornea Unit, The Research Institute of Ophthalmology, Giza, Egypt
| | - Samer Hamada
- Corneoplastic unit and Eye Bank, Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK
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Ferreira GDA, Ghanem VC, Tavares RLDP, Ghanem RC. Toric Artisan after transepithelial topography-guided photorefractive keratectomy for higher-order aberrations following intrastromal corneal ring segments in keratoconus - Trioptics. Indian J Ophthalmol 2020; 68:2564-2567. [PMID: 33120693 PMCID: PMC7774231 DOI: 10.4103/ijo.ijo_73_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: 11/04/2022] Open
Abstract
We report a case of a 40-year-old female with keratoconus and high myopia who had previous ICRS implantation in both eyes (OU) and was intolerant to contact lenses. Manifest refraction was -8.50 -1.50 × 95 (20/25--) in right eye (OD) and -9.50 -2.50 × 60 (20/70--) in left eye (OS). A topography-guided transepithelial-photorefractive keratectomy (ttPRK) was performed to correct high-order aberrations on OS, resulting in corneal surface and coma improvement, and CDVA achieved 20/30. Correction of residual ametropia was performed with an iris-fixated toric phakic lens in OU. CDVA improved to 20/20- (Plano) in OD and 20/20- (Plano -1.00 90°) in OS. In conclusion, it is possible to rehabilitate a patient with keratoconus and high ametropia after intrastromal corneal ring segments (ICRS) implantation associating ttPRK and phakic lens ("Trioptics").
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Affiliation(s)
- Gabriel de Almeida Ferreira
- Department of Cornea, Sadalla Amin Ghanem Eye Hospital, Joinville, SC; Master (MSc) in Ophthalmology at the São Paulo State University, Botucatu, SP, Brazil
| | - Vinícius Coral Ghanem
- Department of Cornea, Sadalla Amin Ghanem Eye Hospital, Joinville, SC; Doctorate (PhD) at the São Paulo University (USP), Sao Paulo, SP, Brazil
| | | | - Ramon Coral Ghanem
- Department of Cornea, Sadalla Amin Ghanem Eye Hospital, Joinville, SC; Doctorate (PhD) at the São Paulo University (USP), Sao Paulo, SP, Brazil
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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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Emerah SH, Sabry MM, Saad HA, Ghobashy WA. Visual and refractive outcomes of posterior chamber phakic IOL in stable keratoconus. Int J Ophthalmol 2019; 12:840-843. [PMID: 31131246 DOI: 10.18240/ijo.2019.05.22] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 01/03/2019] [Indexed: 11/23/2022] Open
Abstract
We evaluated the visual and refractive outcomes after phakic visian toric implantable collamer lens (ICL) insertion in stable keratoconus (KC). This retrospective study investigated toric ICL implantation in 14 eyes of 8 patients with stable KC. After 6mo, the mean uncorrected distance visual acuity improved significantly from 0.77 to 0.15 logMAR. The mean best corrected distance visual acuity (BCDVA) improved from 0.18±0.1 to 0.15±0.1 logMAR. Fifty percent of eyes maintained their preoperative BCDVA; 42.8% gained one line. There was no statistical difference in high order or coma aberration. The mean refractive manifest spherical equivalent (MSE), mean refractive manifest spherical error, mean manifest astigmatism decreased significantly postoperatively. At 6mo postoperatively, our achieved mean spherical equivalent was approximately 74%. No intraoperative or postoperative complications occurred. Toric ICL implantation was effective, predictable and safe to correct refractive error and improve visual acuity in patients with stable KC.
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Affiliation(s)
- Sherif H Emerah
- Ophthalmology Department, Research Institute of Ophthalmology, Giza, Egypt.,Magrabi Eye Hospital, Dubai, UAE
| | - Moataz M Sabry
- Ophthalmology Department, Tanta University, Tanta, Egypt
| | - Hisham A Saad
- Ophthalmology Department, Tanta University, Tanta, Egypt
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Résultats réfractifs et facteurs pronostiques de succès du traitement du kératocône par anneaux intracornéens : étude rétrospective sur 75 yeux. J Fr Ophtalmol 2019; 42:118-126. [DOI: 10.1016/j.jfo.2018.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/03/2018] [Indexed: 11/15/2022]
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Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality. J Ophthalmol 2017; 2017:7589816. [PMID: 29403662 PMCID: PMC5748308 DOI: 10.1155/2017/7589816] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/28/2017] [Indexed: 01/14/2023] Open
Abstract
Keratoconus provides a decrease of quality of life to the patients who suffer from it. The treatment used as well as the method to correct the refractive error of these patients may influence on the impact of the disease on their quality of life. The purpose of this review is to describe the evidence about the conservative surgical treatment for keratoconus aiming to therapeutic and refractive effect. The visual rehabilitation for keratoconic corneas requires addressing three concerns: halting the ectatic process, improving corneal shape, and minimizing the residual refractive error. Cross-linking can halt the disease progression, intrastromal corneal ring segments can improve the corneal shape and hence the visual quality and reduce the refractive error, PRK can correct mild-moderate refractive error, and intraocular lenses can correct from low to high refractive error associated with keratoconus. Any of these surgical options can be performed alone or combined with the other techniques depending on what the case requires. Although it could be considered that the surgical option for the refracto-therapeutic treatment of the keratoconus is a reality, controlled, randomized studies with larger cohorts and longer follow-up periods are needed to determine which refractive procedure and/or sequence are most suitable for each case.
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Tiveron MC, Alió del Barrio JL, Kara-Junior N, Plaza-Puche AB, Abu-Mustafa SK, Zein G, Alió JL. Outcomes of Toric Iris-Claw Phakic Intraocular Lens Implantation After Deep Anterior Lamellar Keratoplasty for Keratoconus. J Refract Surg 2017; 33:538-544. [DOI: 10.3928/1081597x-20170616-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022]
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13
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Feasibility of custom-made hydrogel contact lenses in keratoconus with previous implantation of intracorneal ring segments. Cont Lens Anterior Eye 2015; 38:351-6. [DOI: 10.1016/j.clae.2015.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 02/11/2015] [Accepted: 03/31/2015] [Indexed: 11/21/2022]
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14
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Recent advances in the treatment of corneal ectasia with intrastromal corneal ring segments. Curr Opin Ophthalmol 2015; 26:273-7. [DOI: 10.1097/icu.0000000000000163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
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Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
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