Comparison of deep anterior lamellar keratoplasty and intrastromal corneal ring segment implantation in advanced keratoconus

Özertürk, Yusuf; Sarı, Esin Söğütlü; Kubaloğlu, Anıl; Koytak, Arif; Piñero, David P.; Akyol, Sibel

doi:10.1016/j.jcrs.2011.08.033

Cited by 24 publications

(32 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other wise no statistically significant diffrence was found in the other parameters between both groups post operative. In comparing our results to Yusuf Ozerturk etal., (2012) [14] who compared these two techniques in moderate KC, we found that his results match with our study as he found that there was statistically significant improvement in all post operative parameters compared to the preoperative ones in both groups (UCVA,BCVA,SE and mean K value). in comparing the post operative results between the two groups , he found that there was statistically significant diffrence in all post operative parameters (UCVA,BCVA,SE and mean K value) with the upper hand to the DALK group and explained that by the fact that in DALK he removed the whole diseased tissue.…”

Section: Clarity Of the Corneasupporting

confidence: 88%

Evaluation of Deep Anterior Lamellar Keratoplasty Versus Intracorneal Ring Segments in Treating Moderate Keratoconus

Al-Naimy¹,

Abou-sharkh²,

Aldeeb³

et al. 2017

Zagazig University Medical Journal

View full text Add to dashboard Cite

Background: Keratoconus can cause gradual distortion of vision due to progressive myopia and irregular astigmatism. keratoconus is classified into four stages. The treatment is stage specific starting from glasses or hard contact lenses in the very early stages passing to intra corneal ring segments(ICRS) with or without collagen cross linking(CXL) in the second stage then deep anterior lamellar keratoplasty (DALK) or intra corneal ring segments in the third stage ending with penetrating keratoplasty in the fourth stage. Patients and Methods: This study included 50 Patients from attendants to outpatient clinic Ophthalmology Department, Zagazig University. Those patients were diagnosed as moderate keratoconus according to modified Amsler classification. The patients were divided randomly into 2 equal groups each one involved 25 eyes. The patients of the first group had DALK using the double bubble modification of the Big Bubble (BB) technique while patients of second group had femto assisted intrastromal corneal ring segment (KERA) implantation. The patients were followed up for 12 months. This prospective randomized interventional study aimed to evaluate and compare intracorneal ring segments (ICRS) versus deep anterior lamellar keratoplasty (DALK) in treating moderate keratoconus. A complete ophthalmic examination was performed, including visual acuity, refraction, and keratometric readings. Results: The primary outcome measure in this study was the best corrected visual acuity (BCVA) at the end of follow up period which is 12 months while the secondary outcome measures were the uncorrected visual acuity (UCVA), mean spherical and mean K value. In the first group (DALK group) the mean UCVA preoperatively was 0.05 ± 0.001 and mean BCVA preoperatively was 0.08 ± 0.001while postoperatively the mean UCVA was 0.1 ± 0.02 and mean BCVA postoperatively in the 3 rd month was 0.25 ± 0.02 and in the 6 th month visit was 0.5 ± 0.02. In the second group (ICRS group), the mean preoperative uncorrected visual acuity (Pre UCVA) was 0.06± 0.001 while mean preoperative bestcorrected visual acuity (Pre BCVA) was 0.08± 0.001. The mean postoperative uncorrected visual acuity (post UCVA) was 0.21 ± 0.02 while the mean postoperative best-corrected visual acuity (post BCVA) was 0.4 ± 0.01. All patients of both group had progressive visual improvement in their BCVA compared to the preoperative one. In both groups also, the spherical equivalent, spectacle astigmatism and mean central K value showed significant improvement postoperative compared to preoperative. Conclusion: Both femtoassisted intracorneal ring segments and deep anterior lamellar keratoplasty are safe and effective surgical alternatives in treating patients with moderate keratoconus. Both of them lead to progressive improvement in the visual outcome of keratoconus patients. Achieving the deepest possible interface to reduce scarring, achieve a posterior layer of uniform thickness, perform smooth surface sectioning of both the graft and bed, make the graft tissue of appropr...

show abstract

Section: Clarity Of the Corneasupporting

confidence: 88%

Evaluation of Deep Anterior Lamellar Keratoplasty Versus Intracorneal Ring Segments in Treating Moderate Keratoconus

Al-Naimy¹,

Abou-sharkh²,

Aldeeb³

et al. 2017

Zagazig University Medical Journal

View full text Add to dashboard Cite

show abstract

“…These patients received either ICRS implantation or deep anterior lamellar keratoplasty. ICRS effected a statistically significant increase in visual acuity (corrected and uncorrected distance visual acuity) from baseline to postoperative 24 months (p<0.001) (19) . Similarly, data from a study by El-Husseiny et al, which included 20 eyes of 16 patients, revealed that ICRS (Intacs, Addition Technology, Inc, Sunnyvale, CA) provided a viable alternative to early penetrating keratoplasty for patients with keratoconus having a clear central cornea and a history of contact lens intolerance.…”

Section: Discussionmentioning

confidence: 90%

Intrastromal corneal ring segments delay corneal grafting in patients with keratoconus

Beniz¹,

Queiroz²,

Queiroz³

et al. 2016

Arquivos Brasileiros De Oftalmologia

View full text Add to dashboard Cite

Approved by the following research ethics committee: Hospital das Clínicas, Universidade Federal de Goiás (219.191). ABSTRACT Purpose:To assess the impact of intrastromal corneal ring segments (ICRS) as a surgical alternative to corneal grafting in patients with keratoconus who were scheduled for a corneal transplant. Methods: This single-surgeon, single-center, retrospective, observational case series study included 19 eyes of 18 patients (mean age, 23.36 ± 6.22 years) with a confirmed diagnosis of keratoconus. These patients were enrolled from the State of Goiás, Brazil corneal graft waiting list. Following extensive pre-operative testing, including the measurement of best-corrected visual acuity (BCVA), applanation tonometry, biomicroscopy, funduscopy, pachymetry, and corneal topography, patients were implanted with Keraring® ICRS. Patients underwent clinical examination at postoperative days 1, 7, 30, 90, and 180 and were examined again 2 years following surgery. Results: At the 2-year cut-off following ICRS implantation (mean follow-up, 28.72 ± 4.71 months), there was a statistically significant improvement in BCVA (logMAR) from 0.59 ± 0.35 preoperatively to 0.35 ± 0.45 postoperatively (p<0.01). Three of 19 eyes (15.8%) still required keratoplasty. In the remaining patients (84.2%), BCVA was managed with spectacles (52.6%) or contact lenses (31.6%). One patient developed infectious keratitis, requiring removal of ICR at the first postoperative visit. Conclusion: ICRS implantation may be a surgical alternative to keratoplasty in patients with keratoconus. This procedure may delay or even eliminate the need for keratoplasty in such patients.

show abstract

“…In stable stages of the disease, the preservation of corneal thickness and transparency is crucial at the same time that the optical properties of the patient's own cornea are modified for improving visual acuity and quality of life. This has been attempted with corneal collagen crosslinking [25] and implantation of intracorneal ring segments [26], with very limited or unsuccessful outcomes. The application and implementation of femtosecond laser technology in ocular surgery deliver new opportunities regarding accuracy, programmability and predictability of surgical procedures, as well as an individual approach at the stage of planning and performing the operation [16].…”

Section: Discussionmentioning

confidence: 99%

Femtosecond Laser-Assisted Refractive Autokeratoplasty: A Pilot Study

Sitnik¹,

Slonimsky²,

Slonimsky³

et al. 2016

OJOph

View full text Add to dashboard Cite

Purpose: To develop a new method of femtosecond laser-assisted refractive autokeratoplasty (FRAK) in advanced keratoconus and to evaluate preliminarily early clinical results. Methods: A total of 17 patients with stable advanced keratoconus and a mean age of 33 ± 8.4 years were included in the study. FRAK was performed in all cases with the IntraLase 60 kHz (Abbott Medical Optics Inc.). A 2-step resection of corneal stroma was performed using the femtosecond laser, with the generation of a circular corneal flap with wedge-shaped profile. After flap removal, the corneal wound was sutured. Results: The surgical procedure and early postoperative period were uneventful in all cases. Mean uncorrected distance visual acuity (UDVA) improved significantly from 0.07 ± 0.03 preoperatively to 0.26 ± 0.13 at 3 months after surgery. Improvement in corrected distance visual acuity (CDVA) was observed in 94.1% of cases, with 76.5% of eyes showing an improvement of more than 3 lines. Between 3 and 6 months after surgery, an additional improvement was observed in UDVA and CDVA. Corneal cylinder decreased significantly from 9.1 ± 3.8 D preoperatively to 4.4 ± 2.75 D at 6 months postoperatively. Conclusions: FRAK may be an alternative treatment in stable advanced keratoconus, allowing a significant visual improvement and corneal regularization while saving the patient's own corneal tissue. The non-penetrating nature of the surgical technique helps to minimize the risks associated to this type of surgery. Further research is needed to determine the functional long-term outcomes.

show abstract

Comparison of deep anterior lamellar keratoplasty and intrastromal corneal ring segment implantation in advanced keratoconus

Abstract: Although DALK provided greater improvement in visual acuity and refractive errors in advanced keratoconus cases, ICRS implantation may be an alternative treatment with satisfactory outcomes and less visual impact.

Cited by 24 publications

References 47 publications

Evaluation of Deep Anterior Lamellar Keratoplasty Versus Intracorneal Ring Segments in Treating Moderate Keratoconus

Evaluation of Deep Anterior Lamellar Keratoplasty Versus Intracorneal Ring Segments in Treating Moderate Keratoconus

Intrastromal corneal ring segments delay corneal grafting in patients with keratoconus

Femtosecond Laser-Assisted Refractive Autokeratoplasty: A Pilot Study

Contact Info

Product

Resources

About