Central Corneal Regularization - Optimization of Uncorrected Visual Acuity in Keratoconus Patients

Kaufmann, C.; Bochmann, Frank; Baenninger, Philipp B.; Ma, Thiel

doi:10.1055/s-0032-1328382

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Pre-operative assessment included uncorrected (UDVA) and corrected (CDVA) distant visual acuity, cycloplegic and non-cycloplegic manifest refraction, and slit lamp examination, including dilated fundoscopy and measurement of intraocular pressure. Scheimpflug-based Imaging corneal topo/tomography, obtained by Precisio (iVis Technologies S. r. l., Taranto, Italy), was used for a preoperative diagnostic as the basis for custom surgery planning and pre- and postoperative structural and optical analysis, including the evaluation of HOCMAs [6, 8]. For the measurement of the latter, a parameter describing optical regularity of the corneal surface, named HOCMAs, was introduced by the manufacturer of the Precisio.…”

Section: Methodsmentioning

confidence: 99%

“…In order to gain a better control of visual outcomes in addition to strengthening the cornea, CXL has been combined with other procedures such as laser vision correction, implantation of corneal ring segments, or use of phakic or aphakic intraocular lenses, thus improving eye optics. It seems that corneal surface ablation, performed in the same session as CXL or sequentially, has been the most popular of those procedures [1, 6, 7]. The combined treatment consisting of CXL preceded by a minimally invasive customized trans-epithelial corneal regularization seems to be a promising approach to freezing the keratoectatic process in an optically regularized cornea and achieving a potentially stable improvement of the quality of vision.…”

Section: Introductionmentioning

confidence: 99%

“…An innovative concept introduced by the iVis Suite customized excimer laser ablation treatment platform (iVis Technologies S. r. l., Taranto, Italy), named Central Corneal Regularization (CCR), was reported for the use in keratoconic corneas [6, 7]. The system uses topo/tomography-guided ablation to regularize the corneal shape by eliminating the higher order corneal morphological aberrations (HOCMAs) within a very narrow central optical zone, while the treatment of the HOCMAs towards the periphery gradually decreases within a large total ablation diameter.…”

Section: Introductionmentioning

confidence: 99%

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Central corneal regularization (CCR): an alternative approach in keratoconus treatment

et al. 2019

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BackgroundTo evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking (CXL) to strengthen the corneal tissue and stop the progression of keratoconus. The transepithelial therapeutic ablation applied a novel concept named central corneal regularization (CCR) which could correct the corneal morphological irregularities and the eye’s spherocylindrical refractive error with minimal stromal tissue removal.MethodsRetrospective study. Eyes that underwent CCR combined with CXL were evaluated preoperatively and up to 12 months postoperatively for visual acuity, subjective refraction, corneal haze, pachymetry and maximum keratometry (Kmax).ResultsTwenty four eyes of 24 patients with a mean age of 28.92 ± 9.88 years were treated. The mean spherical equivalent (SE) refractive error changed from − 0.74 ± 1.17 D preoperatively to − 1.05 ± 1.52 D at 12 months postoperatively. The mean uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) improved. No eye lost lines of CDVA, 21 had a mean improvement of 3.21 lines. The mean cylinder error and Kmax value dropped from − 3.06 ± 1.83 D and 51.38 ± 3.29 D to − 1.04 ± 0.80 D and 48.70 ± 2.58 D, respectively. The mean haze score at 3, 6 and 12 months was 0.56, 0.19 and 0.06, respectively.ConclusionsCCR combined with CXL offers promising results as a safe and effective treatment in keratoconic patients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Central corneal regularization (CCR): an alternative approach in keratoconus treatment

et al. 2019

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“…Similarly, a protocol in the name of "Central Corneal Regularization (CCR)" on the iVis Suite customized excimer laser ablation treatment platform (iVis Technologies S. r. l., Taranto, Italy) was tried with keratoconus patients (Amsler-Krumeich stage I-II) and was shown to improve both uncorrected and corrected visual acuity. 71,72 A subsequent comparative study also showed that the combination of the CCR/PRK approach with C-CXL results in a more effective reduction in higher-order aberrations and Kmax than what can be achieved with C-CXL alone. 73 Kanellopoulos AJ modified the Athens protocol by incorporating topographically guided varied pattern C-CXL into the protocol thereby reducing the amount of tissue that has to be removed by PRK.…”

Section: Advances In Treatmentmentioning

confidence: 97%

Advances in the diagnosis and treatment of keratoconus

2021

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Keratoconus had traditionally been considered a rare disease at a time when the imaging technology was inept in detecting subtle manifestations, resulting in more severe disease at presentation. The increased demand for refractive surgery in recent years also made it essential to more effectively detect keratoconus before attempting any ablative procedure. Consequently, the armamentarium of tools that can be used to diagnose and treat keratoconus has significantly expanded. The advances in imaging technology have allowed clinicians and researchers alike to visualize the cornea layer by layer looking for any early changes that might be indicative of keratoconus. In addition to the conventional geometrical evaluation, efforts are also underway to enable spatially resolved corneal biomechanical evaluation. Artificial intelligence has been exploited in a multitude of ways to enhance diagnostic efficiency and to guide treatment. As for treatment, corneal cross-linking treatment remains the mainstay preventive approach, yet the current main focus of research is on increasing oxygen availability and developing new strategies to improve riboflavin permeability during the procedure. Some new combined protocols are being proposed to simultaneously halt keratoconus progression and correct refractive error. Bowman layer transplantation and additive keratoplasty are newly emerging alternatives to conventional keratoplasty techniques that are used in keratoconus surgery. Advances in tissue engineering and regenerative therapy might bring new perspectives for treatment at the cellular level and hence obviate the need for invasive surgeries. In this review, we describe the advances in the diagnosis and treatment of keratoconus primarily focusing on newly emerging approaches and strategies.

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“…The concept of CCR and the iVIS Suite™ platform modules are described in detail elsewhere [19]. In brief, a PrecisioHD™ Scheimpflug tomographer was used to acquire corneal elevation maps, each consisting of 39, 000 measurement points with an auto-validated repeatability of ≤3 μm [20].…”

Section: Surgical Techniquesmentioning

confidence: 99%

Changes in higher order aberrations after central corneal regularization - a comparative two-year analysis of a semi-automated topography-guided photorefractive keratectomy combined with corneal cross-linking

et al. 2020

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Background: The optical quality in progressive keratoconus deteriorates due to ectasia and distortion of the corneal shape and optics. While corneal cross-linking (CXL) aims at stopping disease progression, "CXL-Plus" combines CXL with excimer laser ablation to improve visual function. Central Corneal Regularization (CCR) represents a therapeutic excimer laser modality specifically designed to smoothen the ectatic corneal shape and to reduce higher order aberrations (HOA). We set out to compare CXL-Plus, consisting of CXL combined with CCR, with CXL by itself for patients with progressive keratoconus. Methods: Retrospective 2-year matched group analysis of patients who either underwent CXL-Plus (n = 28) or CXL as a sole procedure (n = 28) for progressive keratoconus. Main outcome parameters were HOA, visual function and tomographic results 12 and 24 months postoperatively. Results: After 12 months, the total HOA root mean square wavefront error was reduced from 0.79 ± 0.30 to 0.40 ± 0.19 μm (CXL-Plus; p < 0.0001) and changed from 0.71 ± 0.28 to 0.73 ± 0.36 μm (CXL; p = 0.814). Uncorrected distance visual acuity improved from 0.70 ± 0.35 to 0.36 ± 0.29 logMAR (CXL-Plus; p = 0.0002) and from 0.65 ± 0.39 to 0.46 ± 0.37 logMAR (CXL; p = 0.067), translating to gains of three or more lines in 50% (CXL-Plus) and 36% (CXL) of patients. The steepest keratometry value (Kmax) regressed by 5.84 D (CXL-Plus; p < 0.0001) and 0.66 D (CXL; p = 0.752). For none of the investigated parameters a statistically significant change could be shown between 12 and 24 months. Conclusions: CXL-Plus in the form of a CCR reduces HOA and Kmax more effectively than CXL as a sole procedure.

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Central Corneal Regularization - Optimization of Uncorrected Visual Acuity in Keratoconus Patients

Abstract: Combined corneal cross-linking and central corneal regularization treatment has the potential to achieve a clinically significant improvement of uncorrected visual acuity.

Cited by 7 publications

References 9 publications

Central corneal regularization (CCR): an alternative approach in keratoconus treatment

Central corneal regularization (CCR): an alternative approach in keratoconus treatment

Advances in the diagnosis and treatment of keratoconus

Changes in higher order aberrations after central corneal regularization - a comparative two-year analysis of a semi-automated topography-guided photorefractive keratectomy combined with corneal cross-linking

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