Anterior Segment Changes After Femtosecond Laser-Assisted Implantation of a 355-Degree Intrastromal Corneal Ring Segment in Advanced Keratoconus

Elaziz, Mohamed Samy Abd; Sarhan, Abdel Rahman El Saebay; Ibrahim, Asmaa Mohammed; Haggag, Haidy Abd Elshafy

doi:10.1097/ico.0000000000001702

Cited by 16 publications

(11 citation statements)

References 19 publications

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“…Most surgical nomograms rely upon the Journal of Ophthalmology axial map to determine the cone location or asymmetry. Instead of constructing a validated and reliable nomogram, simple unexplained instructions are provided with each ring [14][15][16]. Few attempts were reported to create validated nomograms or simulated models to avoid unpredictable events [17].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a Tangential Map-Based Nomogram for Intrastromal Corneal Ring Segments’ Implantation in Keratoconus: One Year Results

Zaky

KhalafAllah

Sarhan

et al. 2020

Journal of Ophthalmology

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is properly cited.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. e 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 to − 1.00 ± 1.6D at 12 months after the procedure. e UDVA gain was significantly higher in the tangential group: 0.35 compared to 0.15 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, P � 0.003 * . At 12 months, the tangential map showed superiority in UDVA, CDVA, and MRSE in the peripheral cone location, but not the central and paracentral ones. Conclusion. e 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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Section: Discussionmentioning

confidence: 99%

Evaluation of a Tangential Map-Based Nomogram for Intrastromal Corneal Ring Segments’ Implantation in Keratoconus: One Year Results

Zaky

KhalafAllah

Sarhan

et al. 2020

Journal of Ophthalmology

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“…On the other hand, Flecha-Lescún et al [57] theoretically hypothesized that implantation of the segments in the posterior corneal stroma could halt KCP while their implantation in the anterior corneal stroma could properly accelerate KCP. On the contrary, to this theory, Abd Elaziz et al [58] evaluated the implantation of 355° Keraring segment in the treatment of advanced KC with central cones. They concluded that this type of segment was effective and revealed marked visual and refractive improvements.…”

Section: Vascularization Opacificationmentioning

confidence: 99%

Long-Term Visual, Refractive and Topographic Outcomes of KeraRings Combined with Accelerated Transepithelial Crosslinking for Management of Different Grades of Progressive Keratoconus: A Retrospective Cohort Study

Iqbal¹,

Mounir²,

Abd-Elaziz³

et al. 2021

TOOPHTJ

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Purpose: To evaluate long-term visual, refractive, and topographic outcomes of KeraRings intrastromal implantation combined with accelerated transepithelial cross-linking for management of different stages of progressive keratoconus. Materials and Methods: This retrospective cohort study included 70 eyes of 70 patients with Amsler-Krumeich grades 1 to 4 keratoconus. They were divided into two groups: group-A included 37 eyes with grades 1-2 keratoconus, and group-B included 33 eyes with grades 3-4 keratoconus. Both groups underwent combined Keraring implantation with TCXL treatment. The main outcome measures included the preoperative and postoperative visual acuity, refraction, keratometry readings, and pachymetry. Results: At postoperative month 60, group-B exhibited significantly higher values of all mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere/cylinder/spherical equivalent/defocus equivalent (DEQ), and K1/K2/Kaverages/Kmax parameters compared to that of group A. However, group-A exhibited better stability of postoperative improvements. Keratoconus progression (KCP) was greater in group-B (45.5%) than group-A (10.8%). Two eyes revealed segments' migration while one eye showed tunnel vascularization and opacification with segments' migration. Conclusion: The diagnostic criteria of preoperative-KCP are not adequate for the diagnosis of postoperative-KCP following ICRS implantation. UDVA and K average posterior seemed to be more sensitive parameters than K max in documenting early postoperative-KCP. We suggest that deterioration of UDVA≥0.10 log MAR and/or K average posterior ≥0.25 D are highly suspicious of post-ring implantation keratoconus progression (PR-KCP). The occurrence of two of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, K average posterior ≥0.25 D, or pachymetry≥1.5% thinning, is diagnostic of PR-KCP. The occurrence of two or more of the following parameters: Kmax≥0.50 D, Kaverageanterior≥0.50 D, Kaverageposterior ≥0.25 D, pachymetry≥ 1.5% thinning or UDVA≥0.10 logMAR, is diagnostic of PR-KCP. We also suggest that Kmax≥0.75 D alone is diagnostic of PR-KCP.

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“…4 The benefits of ICRS have been established in the literature for the treatment of keratoconus, with much less risk involved, showing to be an effective and safe alternative for the treatment of the condition. [5][6][7][8][9] However, the intracorneal ring has been limited to eyes with Kmax (maximum keratometry) values less than 58 D, as larger curvatures could be associated with worse visual outcomes and more complications, such as extrusion. 10 Despite the existing studies on ring implants addressing the outcomes of intracorneal ring implantation in advanced keratoconus, these studies are limited to patients with maximum curvatures lower than 60D.…”

Section: Introductionmentioning

confidence: 99%

“…10 Despite the existing studies on ring implants addressing the outcomes of intracorneal ring implantation in advanced keratoconus, these studies are limited to patients with maximum curvatures lower than 60D. 8,11,12 This is the first study to show the results of the Ferrara ring of 320°o f arc (AJL, Vitoria, Spain) as an alternative therapy in patients with advanced keratoconus, grade IV, with Kmax > 60D, intolerant to contact lens, and with indication for corneal transplantation.…”

Section: Introductionmentioning

confidence: 99%

“…The benefits of ICRS have been established in the literature for the treatment of keratoconus, with much less risk involved, showing to be an effective and safe alternative for the treatment of the condition. 5–9 However, the intracorneal ring has been limited to eyes with Kmax (maximum keratometry) values less than 58 D, as larger curvatures could be associated with worse visual outcomes and more complications, such as extrusion. 10…”

Section: Introductionmentioning

confidence: 99%

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Results of intrastromal corneal ring implantation in advanced keratoconus With the aim of postpoing or avoiding corneal transplantation

Soares,

Chaves,

Torquetti

et al. 2023

European Journal of Ophthalmology

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Purpose To evaluate the safety and efficacy of the surgery of intracorneal ring segment implantation with 320° of arc (320-ICRS) in patients with advanced keratoconus stage IV and maximum keratometry (Kmax) above 60 D. Methods A prospective, interventional case series study evaluating 25 eyes of 19 patients with keratoconus stage IV and Kmax > 60D in which 320-ICRS were implanted using VisuMax® femtosecond. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometric values (mean - mean-K, flat - K1, and steep - K2), maximum keratometry (Kmax), tomographic astigmatism, refractive astigmatism and asphericity (Q) were assessed preoperatively and at 3, 6 and 12 months after the procedure. Results The UDVA improved from 1.03 ± 0.28 LogMAR (20/200) to 0.54 ± 0.21 LogMAR (20/60), (p < 0.001), the CDVA (with glasses) improved from 0.63 ± 0.29 LogMAR (20/80) to 0.31 ± 0.16 LogMAR (20/40),(p = 0.004), K1 reduced from 54.41 ± 4.46 D to 49.36 ± 4.11 D (p < 0.001), K2 reduced from 61.15 ± 4.37 D to 53.715 ± 4.05 D, (p < 0.001), mean-K reduced from 57.55 ± 4,17 D to 51.44 ± 3,94 D (p < 0.001), Kmax reduced from 69.80 ± 8.20 D to 63.43 ± 6.31 D (p < 0.001) and asphericity (Q) changed from −1.57 ± 0.35 to −0.77 ± 0.56 (p < 0.001). A total of 89.9% patients reached BCVA wearing scleral contact lens 0.2 LogMAR(20/25). Conclusion 320-ICRS to treat advanced keratoconus appears to be an efficacious and safe procedure, being a surgical alternative to delay or even prevent corneal transplantation.

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Anterior Segment Changes After Femtosecond Laser-Assisted Implantation of a 355-Degree Intrastromal Corneal Ring Segment in Advanced Keratoconus

Cited by 16 publications

References 19 publications

Evaluation of a Tangential Map-Based Nomogram for Intrastromal Corneal Ring Segments’ Implantation in Keratoconus: One Year Results

Evaluation of a Tangential Map-Based Nomogram for Intrastromal Corneal Ring Segments’ Implantation in Keratoconus: One Year Results

Long-Term Visual, Refractive and Topographic Outcomes of KeraRings Combined with Accelerated Transepithelial Crosslinking for Management of Different Grades of Progressive Keratoconus: A Retrospective Cohort Study

Results of intrastromal corneal ring implantation in advanced keratoconus With the aim of postpoing or avoiding corneal transplantation

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