Safety and efficacy of Intacs in Indian eyes with keratoconus: an initial report

Efficacy of Different Procedures of Intra-Corneal Ring Segment Implantation in Keratoconus: a Systematic Review and Meta-Analysis

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.

Corneal refractive power and eccentricity in the 40- to 64-year-old population of Shahroud, Iran

PURPOSE

To determine the normal corneal curvature, power, and eccentricity in an Iranian population and their determinants.

METHODS

This report is part of a population-based study conducted in 2009. Of the 5190 participants of the study, Pentacam data from 8532 eyes of 4266 people who met the inclusion criteria for this analysis were used. For each eye, we extracted minimum and maximum keratometry readings, the average of the 2 readings (mean-K), the difference between these 2 parameters (keratometric astigmatism), and corneal eccentricity.

RESULTS

The average mean-K, keratometric astigmatism, and eccentricity were 43.73 ± 2.47, 0.90 ± 0.93, and 0.27 ± 0.63 diopter, respectively. Mean-K was directly correlated with age; inversely correlated with body mass index, axial length, white-to-white corneal diameter, and anterior chamber depth; increased at higher amounts of myopia; and was higher in women compared with men. Keratometric astigmatism was significantly higher in women, increased at higher amount of refractive error, but showed no association with other variables. Eccentricity was correlated indirectly with age and white-to-white corneal diameter, and directly with axial length. It increased with myopia.

CONCLUSIONS

Compared with other studies, the mean corneal power and eccentricity values were lower in this Iranian population sample. Our findings may have implications for clinical interventions, especially refractive surgery. Further studies can identify the causes of such differences in the shape and size of the cornea, which may also be attributable to the choice of the measuring device.