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Omar Yousif M, Elkitkat RS, Hamza MN, Abdelsadek Alaarag N. Application of a Revised Tissue Saving Protocol for Combined Topography-Guided Photorefractive Keratectomy and Cross-Linking in a Cohort Having Pellucid Marginal Degeneration. Clin Ophthalmol 2024; 18:303-311. [PMID: 38317793 PMCID: PMC10840534 DOI: 10.2147/opth.s449766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose To evaluate the efficiency, safety, and stability of a revised tissue-saving treatment protocol in a cohort having pellucid marginal degeneration (PMD). Methods A retrospective cohort study was conducted on patients with PMD and no previous treatments. A revised protocol of topo-guided photorefractive keratectomy to be followed by customized phototherapeutic keratectomy and then corneal crosslinking was evaluated by comparing the pre and postoperative outcomes regarding visual (subjective refraction) and topographic (using data from Sirius CSO topography software) outcomes. Results There were both statistically significant and clinically relevant improvements in the postoperative parameters, where each of the unaided and corrected visual acuity, spherical equivalent, refractive cylinder, K readings, topographic cylinder, inferior minus superior difference at the 2- and 4- mm diameters, coma aberration, and higher order aberrations were significantly better postoperatively (all p values were less than 0.01, except for maximum k readings where the p-value was 0.017). The safety and efficacy indices for the surgical procedure were remarkably high (1.53 ± 0.70 and 0.90 ± 0.32, respectively). Conclusion Our proposed tissue-saving protocol (which showed satisfactory results in keratoconus cases according to a previously published article by our research team) has proven its successful outcomes (both topographically and visually) in cases of PMD, which is a rare ectatic entity with guarded prognosis using the available conventional ectasia treatment modalities.
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Affiliation(s)
- Mohamed Omar Yousif
- Ophthalmology department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Maadi Eye Subspecialty Center, Cairo, Egypt
| | - Rania Serag Elkitkat
- Ophthalmology department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
- Watany Research and Development Center, Watany Eye Hospital, Cairo, Egypt
- Ophthalmology Department, Faculty of Medicine, MTI University, Cairo, Egypt
| | - Mohamed Nabil Hamza
- Ophthalmology department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Tas MD, Ahmadlı E, Barut Selver O. A rare clinical complication in a rare clinical presentation: hydrops and reverse pellucid marginal degeneration. Clin Exp Optom 2023:1-3. [PMID: 36972552 DOI: 10.1080/08164622.2023.2192340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Affiliation(s)
| | - Emil Ahmadlı
- Department of Ophthalmology, Ege University, Izmir, Turkey
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Abstract
Objective: To describe the results of toric intraocular lens (IOL) implantation in three atypical cases (four eyes) with cataract and corneal astigmatism: one with bilateral keratoconus, one with pellucid marginal degeneration and one with buphthalmos due to congenital glaucoma. Methods: Three patients (four eyes) with corneal astigmatism (one with bilateral keratoconus, one with pellucid marginal degeneration and one with buphthalmos due to congenital glaucoma) underwent cataract surgery by standard phacoemulsification and the implantation of toric IOLs in the capsular bag. The presence of corneal astigmatism was identified by automated keratometry and confirmed by Scheimpflug-based corneal tomography. The toric IOL implanted in all cases was a single-piece AcrySof Toric IOL (Alcon Laboratories, Inc.). Postoperative visual acuity, the reduction in the refractive astigmatism, the spherical equivalent (SE) and the rotational stability of the toric IOL were recorded for all the patients. Results: Visual acuity increased and the refractive astigmatism decreased in all cases. In Case 1, the right eye achieved a postoperative uncorrected visual acuity (UCVA) of 20/ 20, a decrease in the refractive astigmatism from -3 DCyl to -0.75 DCyl and a spherical equivalent (SE) of -0.25. The left eye presented with a best-corrected visual acuity (BCVA) of 20/ 20, a decrease in the refractive astigmatism from -1.50 DCyl to -1.25 DCyl and a SE of -0.25. In Case 2, the postoperative UCVA was 20/ 20, with a decrease in the refractive astigmatism from -5.5 DCyl to -1 DCyl and a SE for the right eye of 0.00 D. In Case 3, the postoperative BCVA was 20/ 20, with a decrease in the refractive astigmatism from -4.75 DCyl to -1.50 DCyl and a SE of +1.25. No misalignment of the axis of the toric IOL was observed in any patient at subsequent follow-ups. The postoperative visual acuity was satisfactory for all the patients. Conclusions: Toric intraocular lenses can be an effective option for implantation in patients with cataract and corneal astigmatism in atypical situations such as mild to moderate keratoconus, pellucid marginal degeneration and buphthalmos due to congenital glaucoma. Predicting the refractive outcome is difficult in atypical cases and the surgeon should have accuracy and consistency in the preoperative measurements, for achieving satisfactory postoperative results.
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Affiliation(s)
- Alina Simona Lazăr
- "Prof. Dr. Agrippa Ionescu" Clinical Emergency Hospital, Bucharest, Romania
| | - Bogdana Tăbăcaru
- "Prof. Dr. Agrippa Ionescu" Clinical Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Simona Stanca
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Tudor Horia Stanca
- "Prof. Dr. Agrippa Ionescu" Clinical Emergency Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Bajracharya L, Agrawal N, Dhungel S, Parajuli R, Adhikari S. A Teenager with Vernal Keratoconjunctivitis and Pellucid Marginal Degeneration, Presenting with Exotropia. Int Med Case Rep J 2020; 13:399-408. [PMID: 32982479 PMCID: PMC7498931 DOI: 10.2147/imcrj.s262999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background Vernal keratoconjunctivitis (VKC), an allergic disease, has a known association with ectatic disorders of the cornea. Pellucid marginal degeneration (PMD) is a bilateral, asymmetrical, ectatic disorder of the cornea characterized by inferior corneal thinning. We report a case of sensory exotropia due to PMD in association with VKC. Case Details A 19-year old boy with a history of VKC presented with exotropia of the right eye of 3 years’ duration. His unaided vision in his right eye was 1/60 and in his left eye it was 6/36. On examination, both eyes had high against the rule astigmatism, which was more in the right eye. There was exotropia of 15º (40 prism diopter base in) in the right eye with suppression (Worth four dot test). Corneal examination in both eyes showed inferior band thinning, 2 mm above the inferior limbus, extending from 4 to 8 clock hours, with bulging of the cornea just above the thinning. The clinical features were suggestive of PMD, which was supported by his corneal scans – Atlas, Pentacam, and Optovue. Although he was undergoing treatment for VKC, the onset of PMD and decrease in vision went unnoticed. The asymmetric error which was not corrected during the sensitive period of visual development led to sensory exotropia. Conclusion A child with VKC should undergo regular refraction so as not to miss any ectatic changes occurring in the cornea. A delay in diagnosing corneal ectasia may negate the possibility of collagen cross-linking which prevents progression of ectasia. If visual rehabilitation is delayed beyond the age of visual maturation, it can lead to strabismus, suppression, and loss of binocular function.
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Affiliation(s)
- Leena Bajracharya
- Cornea Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Nisha Agrawal
- Pediatric Ophthalmology and Strabismus Department, Taparia Eye Care, Biratnagar, Nepal
| | - Shashwat Dhungel
- Department of Refractive Surgery, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Rojeeta Parajuli
- Pediatric Ophthalmology and Strabismus Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Srijana Adhikari
- Pediatric Ophthalmology and Strabismus Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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Kymionis G, Voulgari N, Samutelela E, Kontadakis G, Tabibian D. Combined Corneal Wedge Resection And Corneal Cross-Linking For Pellucid Marginal Degeneration: A First Report. Ther Clin Risk Manag 2019; 15:1319-1324. [PMID: 31814727 PMCID: PMC6858838 DOI: 10.2147/tcrm.s210606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/15/2019] [Indexed: 11/23/2022] Open
Abstract
Background Advanced pellucid marginal degeneration is a debilitating disease that warrants the use of surgery when the visual acuity is reduced and contact lenses are not tolerated anymore. It is traditionally managed with corneal transplantation, however alternative surgical options exist. Corneal wedge resection allows for good visual rehabilitation without the risks of tissue rejection. However topographical and refractive results are in some instance fluctuating. We present here the use of corneal cross-linking in order to stabilize the parameters on the long term. Case presentation We present here the case of a 53 years old patient with bilateral advanced pellucid marginal degeneration. As he is now intolerant to contact lenses a surgical option is offered to him. In order to avoid using donated tissue through corneal grafting we decide to perform a sectorial lamellar crescentric wedge excision of the thinner inferior part of the cornea involving the pellucid marginal degeneration and suture it. The first eye shows initial good results however after few months regression is observed. The second eye is then treated with the same surgical technique combined with cornea cross-linking. Long-term follow-up shows stabilization and absence of regression in the second eye up to eight months after the surgery. Conclusion Combining corneal cross-linking with corneal wedge resection in the case of advanced pellucid marginal degeneration patients could be a good option in order to stabilize topographical and refractive results and reduces the risk of regression.
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Affiliation(s)
- George Kymionis
- Ophthalmology Department, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Nafsika Voulgari
- Ophthalmology Department, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Erwin Samutelela
- Ophthalmology Department, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - George Kontadakis
- Ophthalmology Department, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - David Tabibian
- Ophthalmology Department, University of Lausanne, Jules Gonin Eye Hospital, Lausanne, Switzerland
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Koc M, Kosekahya P, Inanc M, Tekin K. Corneal crosslinking in a case with Axenfeld-Rieger syndrome and unilateral pellucid marginal degeneration. Ther Adv Ophthalmol 2019; 11:2515841418822288. [PMID: 30729234 PMCID: PMC6350116 DOI: 10.1177/2515841418822288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/07/2018] [Indexed: 11/17/2022] Open
Abstract
A 31-year-old male patient presented with the complaint of progressive vision loss in his left eye. Slit-lamp examination showed posterior embryotoxon, iris hypoplasia, and iridocorneal adhesion in both eyes, corectopia in the right, and peripheral inferior thinning and ectasia in the left eye. Corneal topography showed slightly asymmetric bowtie pattern in the right eye and crab-claw pattern in the left eye. Topographic examination was compared with his previous topography. The comparison showed 1.6-D steepening of maximum keratometry (Kmax) and 22-µm decrease of thinnest corneal pachymetry. Corneal crosslinking treatment was performed on the left eye. At the postoperative 28-month follow-up visit, Kmax decreased from 54.1 to 53.0 D and corrected distance visual acuity improved to 20/20 with scleral lens. This is the first reported a case with Axenfeld–Rieger syndrome and pellucid marginal degeneration association. We suggest that corneal crosslinking can be useful for management of pellucid marginal degeneration and longer follow-up might be needed in order to corroborate the effectiveness of the corneal crosslinking procedure.
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Affiliation(s)
- Mustafa Koc
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Pinar Kosekahya
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Merve Inanc
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Ercis State Hospital, Van, Turkey
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Vlasák O, Škorpíková J, Hlinomazová Z, Kalandrová V. Yield of Display Modules of Corneal Tomography for Early Diagnosis of Corneal Ectasia. Cesk Slov Oftalmol 2019; 74:175-183. [PMID: 31234630 DOI: 10.31348/2018/5/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The thesis deals with comparison of topographic corneal indexes and their importance for the diagnosis of corneal ectatic disease. The corneas with different stages of keratoconus, forme fruste keratoconus, pellucid marginal degeneration, corneal warpage syndrome, and physiological cornea with varying values of regular astigmatism were included in the tested group. The study was conducted in 2015-2018 at the European Eye Clinic Lexum Brno. The study group contained 208 eyes, 111 eyes with keratoconus, 31 eyes with forme fruste keratoconus, 23 eyes with pellucid marginal degeneration, 10 eyes with corneal warpage syndrome and 33 physiological eyes. 19 corneal parameters and indexes were monitored for these ectatic diseases, which were compared with healthy corneas with regular astigmatism. A single-factor ANOVA test, a Student t-test were used for statistical analysis. Pearson's coefficients were used to assess the correlation. In all the observed tomographic parameters a statistically significant difference was found between the physiological and ectatic group of corneas. The parameters with the highest statistical difference were BEThLo, ISV, IHD, D, Rmin. Statistically significant indices were also found between the forme fruste keratoconus and physiological corneas. The best parameters for detecting the subclinical keratoconus were the back elevation at the thinniest point of the cornea (BEThLo), the difference between the thinniest and the central point of cornea (CP-TL), the maximum pachymetic progression index and the Db and D indexes (p 0.6) according to Pearson's correlation coefficient. Statistically significant differences in the KK and PMD groups were found in the index of relative pachymetry, central pachymetry, CKI and Dp. Key words: Pentacam, corneal ectasia, keratoconus, pellucid marginal degeneration, corneal warpage syndrome, forme fruste keratoconus.
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Lohchab M, Prakash G, Arora T, Maharana P, Jhanji V, Sharma N, Vajpayee RB. Surgical management of peripheral corneal thinning disorders. Surv Ophthalmol 2018; 64:67-78. [PMID: 29886126 DOI: 10.1016/j.survophthal.2018.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Abstract
The peripheral corneal thinning disorders are associated with degenerative, autoimmune, or infective causes. Corneal thinning can subsequently affect the visual acuity either by inducing severe astigmatism or by progressive involvement of the central cornea. In addition to this, the integrity of the eye is at risk. Medical management is necessary to address the underlying inflammatory or infectious causes; however, most of the cases require surgical intervention for tectonic support or for visual rehabilitation in patients with severe astigmatism. Preoperative investigations help in mapping the corneal curvature and thickness, thereby facilitating planning of treatment. Routine corneal transplantation techniques do not yield good results in peripheral corneal thinning disorders. Various surgical modifications have been described to manage these challenging cases. We review the available literature on causes and management of peripheral corneal thinning disorders.
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Affiliation(s)
- Monica Lohchab
- Cornea and Phacorefractive services, Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India
| | - Gaurav Prakash
- NMC eye care, New Medical Centre Specialty Hospital, Abu Dhabi, UAE
| | - Tarun Arora
- Eye Care Centre, Princess Margaret Hospital, Nassau, New Providence, Bahamas
| | - Prafulla Maharana
- RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Jhanji
- University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Namrata Sharma
- RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rasik B Vajpayee
- Vision Eye Institute, Melbourne, Australia; Royal Victorian Eye and Ear Hospital, Melbourne, Australia; North West Academic Centre, University of Melbourne, Australia.
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Mamoosa B, Razmjoo H, Peyman A, Ashtari A, Ghafouri I, Moghaddam AG. Short-term result of collagen crosslinking in pellucid marginal degeneration. Adv Biomed Res 2016; 5:194. [PMID: 28217632 PMCID: PMC5220691 DOI: 10.4103/2277-9175.192732] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 08/27/2014] [Indexed: 12/02/2022] Open
Abstract
Background: To evaluate effectiveness of collagen crosslinking in pellucid marginal degeneration patients. Materials and Methods: Twenty-one eyes of 15 patients treated by collagen crosslinking were enrolled in our non-controlled clinical trial study. After evaluation of patients about inclusion and exclusion criteria, preoperative examination was done and then patients underwent CXL procedure and seen 6 months after surgery for postoperative examinations. Results: Mean preoperative LogMar uncorrected visual acuity (UCVA) was 0.63 (SE = 0.08), and mean preoperative LogMar BCVA was 0.26 (SE = 0.04). At 6 months postoperative, mean LogMar UCVA was 0.59 (SE = 0.06) and mean LogMar BCVA was 0.19 (SE = 0.02). The non-parametric test (Wilcoxon) showed reduction of LogMar BCVA was significant (P value = 0.02), but reduction of LogMar UCVA was not significant (P value = 0.5). Mean preoperative K1 was 42.23 ± 2.85 and mean postoperative K1 significantly decreased to 41.68 ± 2.44 (P value = 0.008). Also, mean preoperative K2 was 48.39 ± 2.37 and mean postoperative K2 significantly reduced to 47.64 ± 2.16 (P value = 0.002). Conclusion: Most remarkable findings of our study were improvement of visual acuity and reduction K1 and K2 parameters. Stability of other values and absence of detectable change after study period implies halting of the progression of the disease. We suggest CXL can be useful for management of PMD, but we need more studies with larger sample size and longer follow up.
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Affiliation(s)
- Bashir Mamoosa
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hassan Razmjoo
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Peyman
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ashtari
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Ghafouri
- Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
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Al-Motowa S, Al-Harby M. Surgical Treatment of Corneal Ectasia with Motowa's Trephine and Selective Suturing Technique. Middle East Afr J Ophthalmol 2016; 23:315-317. [PMID: 27994396 PMCID: PMC5141626 DOI: 10.4103/0974-9233.194087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 40-year-old male presented with bilateral ectasia, contact lens intolerance, and astigmatism >10 D in both eyes. The patient had end-stage pellucid marginal degeneration that warranted surgical treatment. We present a unique surgical technique to stabilize the cornea, minimize astigmatism, improve vision and corneal status, and avoid penetrating keratoplasty.
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Affiliation(s)
- Saeed Al-Motowa
- Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Mosa Al-Harby
- Cornea and Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Abstract
Purpose This study evaluated the clinical performance of KeraSoft® IC (KIC) soft contact lenses in subjects with irregular corneas. Patients and methods This was a 12-month, prospective, open-label, observational study, which enrolled 43 subjects who were 18 years of age or older with irregular corneas. Subjects were fit according to the KIC Fitting Manual (kerasoftic.com). After achieving best fit according to the fitting manual, lenses were assessed for comfort, vision, centration, rotation, and movement. Subjects were instructed to wear their lenses between 8 and 16 hours each day. Assessments at the exit visit included logMAR visual acuity with high and low contrast, spherocylindrical overrefraction, slit-lamp findings, adverse events, and subjective outcomes. Results The average base curve was 8.17±0.32 mm (n=70 eyes), and the average diameter dispensed was 14.53±0.12 mm (n=70 eyes). From the baseline to 12 months, there was statistically significant improvement in logMAR visual acuity with high contrast (P=0.038), but no significant difference in low-contrast visual acuity was observed (P>0.05). Slit-lamp findings were ≤ grade 1 for the majority of subjects (89%). Two nonserious adverse events were reported for two of the 84 enrolled eyes (two subjects). At 12 months, subjects reported improvements from habitual baseline for comfort and vision, both upon insertion and just before removal of lenses. Conclusion Clinical outcomes at 12 months showed good visual, safety, and subjective outcomes for subjects with corneal irregularities who wore KeraSoft® IC soft contact lenses.
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Affiliation(s)
- Stephanie Su
- Visionary Eye Associates of Rochester, Rochester, NY, USA
| | - Lynette Johns
- Custom Lab Channel Business, Bausch & Lomb Incorporated, Wilmington, MA, USA
| | - Marjorie J Rah
- Medical Affairs - Vision Care, Bausch & Lomb Incorporated, Rochester, NY, USA
| | - Robert Ryan
- Visionary Eye Associates of Rochester, Rochester, NY, USA
| | - Joseph Barr
- Medical Affairs - Vision Care, Bausch & Lomb Incorporated, Rochester, NY, USA
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Abstract
Myopic astigmatism is a prevalent condition that can be treated with spectacles, contact lenses, or laser refractive surgery. However, these treatment options have functional limitations at higher levels of refractive error. The toric implantable collamer lens is designed to treat a broad range of refractive error, generally up to -18 diopters with +1 to +6 diopters of astigmatism. Approval for a more limited treatment range of up to 15 diopters of myopia with +1 to +4 diopters of astigmatism is being sought in the US, where this device has not yet received marketing approval. Surgical correction of high-myopic astigmatism can be life-altering and allow people to participate in activities that were not previously feasible because of visual limitations. The toric implantable collamer lens is implanted behind the iris and in front of the natural crystalline lens. With earlier lens designs, it was necessary to create an iridectomy or iridotomy to prevent pupillary block. The newest toric implantable collamer lens model has a small central hole that is not visually noticeable. This eliminates the need to create a hole in the iris, thereby enhancing the safety of the procedure.
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Affiliation(s)
- Marianne O Price
- Cornea Research Foundation of America, 9002 N. Meridian St, Suite 212, Indianapolis, IN 46260, USA
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Hassan Z, Nemeth G, Modis L, Szalai E, Berta A. Collagen cross-linking in the treatment of pellucid marginal degeneration. Indian J Ophthalmol 2014; 62:367-70. [PMID: 23571261 PMCID: PMC4061688 DOI: 10.4103/0301-4738.109523] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 03/14/2012] [Indexed: 11/18/2022] Open
Abstract
Pellucid marginal degeneration (PMD) is an uncommon cause of inferior peripheral corneal thinning disorder, characterized by irregular astigmatism. We analyzed a case of bilateral PMD patient and treated one eye with corneal collagen cross-linking (CXL) therapy. Corneal topography was characteristic for PMD. Visual acuity, slitlamp examinations, tonometry, and corneal thickness were observed. Simulated keratometric and topographic index values were detected with corneal topography. Uncorrected, LogMAR visual acuity has improved from +0.8 to +0.55 during the 6 months and +0.3 during the 8 months follow-up after CXL. Pachymetry values and intraocular pressure showed no changes. Keratometric values and topografic indexes disclosed no progression of the disease. CXL may postpone or eliminate the need of corneal transplantation in cases with PMD.
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Affiliation(s)
- Ziad Hassan
- Orbident Refractive Surgery and Medical Center, University of Debrecen, Debrecen, Hungary
| | - Gabor Nemeth
- Department of Ophthalmology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Laszlo Modis
- Department of Ophthalmology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Eszter Szalai
- Department of Ophthalmology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Andras Berta
- Department of Ophthalmology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
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Kozobolis V, Labiris G, Gkika M, Sideroudi H. Additional applications of corneal cross linking. Open Ophthalmol J 2011; 5:17-8. [PMID: 21448300 PMCID: PMC3065117 DOI: 10.2174/1874364101105010017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 10/15/2010] [Accepted: 11/03/2010] [Indexed: 11/26/2022] Open
Abstract
Corneal collagen cross-linking (CxL) is a prevalent surgical method for the management of keratoconus. However, literature suggests that, further to keratoconus, CxL has a beneficial impact on a series of corneal related diseases and states. This article attempts to provide a contemporary review for all additional applications of CxL. Specifically, it outlines the most recent studies that demonstrate the beneficial impact of CxL for iatrogenic ectasias, pellucid marginal degeneration, infectious keratitis, bullous keratitopathy, and for ulcerative keratitis. The outcome of this review indicates that CxL could serve as a primary or adjuvant therapeutic modality for all aforementioned corneal-related pathologic states.
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Affiliation(s)
- Vassilios Kozobolis
- Eye Institute of Thrace (EIT), Democritus University, Alexandroupolis, Greece
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