Corneal inlay implantation complicated by infectious keratitis

Duignan, Emma; Farrell, S; Treacy, Maxwell P; Fulcher, Tim; O’Brien, Paul D.; Power, William; Murphy, Conor C

doi:10.1136/bjophthalmol-2015-306641

Cited by 26 publications

(18 citation statements)

References 28 publications

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“…The healing response is a major risk of an adverse outcome with possible stromal thickening over the inlay causing a hyperopic shift from the flattened overlying epithelium [28]. Other adverse events have been reported such as corneal haze, epithelial iron deposition, and infectious keratitis [48, 49]. Unwanted outcomes can be handled by removing the inlay.…”

Section: Kamra Small Aperture Inlaymentioning

confidence: 99%

A Review of Presbyopia Treatment with Corneal Inlays

2017

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The prevalence of presbyopia continues to increase every year. The therapeutic approaches to presbyopia cover the spectrum of non-surgical to surgical techniques. With recent advances in biocompatible materials, corneal inlays make a strong case for their place within the treatment spectrum. This article takes a closer look at three of the current corneal inlay models: KAMRA, Raindrop, and Presbia Flexivue Microlens. Each design approach and mode of action is described with data from key clinical trials. Furthermore, the ability to choose the most suitable corneal inlay is presented by comparing each model and identifying their similarities and differences. The article then concludes by touching on the future of corneal inlays, looking at associated conditions and complications and how to manage them, as well as an expert’s personal point of view of enhanced ideas for continuing the growth and success of corneal inlays in the market.

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Section: Kamra Small Aperture Inlaymentioning

confidence: 99%

A Review of Presbyopia Treatment with Corneal Inlays

2017

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“…When the inlay is removed, the patient’s visual acuity returns to ranges comparable to the preoperative state 11,15,16. In the FDA clinical trials, 15 (3%) patients had their inlay removed at 12 months, 36 (7%) at 24 months, and 44 (8%) at 36 months.…”

Section: Discussionmentioning

confidence: 99%

“…Patient satisfaction after KAMRA inlay has been evaluated by several studies and has been shown to be good 7,9,11,17. Patient satisfaction from the FDA clinical trials was not reported.…”

Section: Discussionmentioning

confidence: 99%

“…If the distance between the center of the pupil and the first Purkinje reflex was <300 μm, the marker was centered on the Purkinje reflex. The decision to center the KAMRA inlay on the first Purkinje reflex was based on the view that it is the best reference point for the visual axis 11. If the distance between the center of the pupil and the Purkinje reflex differed by >300 μm, the marker was centered halfway between the two.…”

Section: Methodsmentioning

confidence: 99%

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Six-month visual outcomes for the correction of presbyopia using a small-aperture corneal inlay: single-site experience

Moshirfar¹,

Quist²,

Skanchy³

et al. 2016

OPTH

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ObjectiveThe objective of this study was to describe 6-month postoperative efficacy and safety outcomes after monocular KAMRA corneal inlay implantation in emmetropic presbyopic patients.Study designThis study followed a retrospective chart analysis.SettingThis study was performed at Hoopes Vision in Draper, UT, USA.Subjects and methodsFifty-seven patients met the inclusion criteria of this study and underwent KAMRA corneal inlay implantation following the approval of the United States Food and Drug Association between May 2015 and April 2016 at a single site. Surgery involved femtosecond laser-created corneal pockets of various depths. Efficacy, safety, and patient satisfaction reports were analyzed at 3 and 6 months.ResultsAt 6 months follow-up, the monocular uncorrected near visual acuity (UNVA) was Jaeger (J) 4 (20/32), the mean uncorrected distance visual acuity was 20/25, and the mean corrected distance visual acuity was 20/20. At 6 months, 71% of patients with a pocket depth of ≥250 μm had a UNVA of 20/20 or better, whereas only 22% of patients with a shallow pocket depth of <250 μm had a UNVA of 20/20 or better. There was no statistical difference in UNVA at 6 months between virgin eyes and post-LASIK eyes. One patient had an explant and five patients underwent inlay recentration, all of which resulted in improved visual acuity. At 6 months, 72% of patients reported some level of satisfaction, 26% of patients reported being “not dependent” on reading glasses, and 62% of patients reported being able to do most things in bright light without reading glasses.ConclusionFor patients with emmetropic presbyopia, the KAMRA inlay is a viable treatment option resulting in improved UNVA. Increased pocket depth may be associated with better postoperative outcomes. Safety rates are high, while explantation and recentering rates are low. Overall, patient satisfaction of the KAMRA inlay is good.

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“…In a series of 5 eyes, patients presented from 6 days to 4 months postoperatively. 37 All patients responded to broad-spectrum fortified topical antibiotics; however, all patients lost corrected vision. At last follow-up, 2 inlays were explanted and 3 remained in situ.…”

Section: ' Postoperative Complicationsmentioning

confidence: 99%

Complications of Intracorneal Implants in Refractive Surgery

Hood

2016

International Ophthalmology Clinics

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In refractive surgery, the use of intracorneal implants, including intracorneal ring segments (ICRS) and corneal inlays, offer the specific advantage of not removing corneal tissue. As such, they are removable and may preserve options for ametropia or presbyopia correction with current or future modalities. 1,2 However, there are unique intraoperative and postoperative complications that can occur with their implantation that need to be recognized and managed. The following review will focus on the incidence and management of complications from the use of intracorneal implants in refractive surgery. ' ICRS for Correction of MyopiaICRS are polymethylmethacrylate segments implanted in the deep corneal stroma to modify the corneal curvature based on their geometric profile and diameter. Although initially approved for low myopia in the United States in 1999, 2 the technology was soon after used for the treatment of keratoconus. 3 The creation of channels for the placement of ICRS can be performed either mechanically using semicircular dissectors or with a femtosecond laser. Although the femtosecond laser creates channels with a high degree of precision, no published studies have demonstrated higher complications or inferior refractive outcomes for myopia with mechanical channel creation. For the treatment of myopia, ICRS offer the advantage over ablational laser refractive surgery of sparing the visual axis with very low risk of central corneal haze or scarring, and the effects may be reversible with removal of the segments. 2,4,5 Although corneal excimer laser refractive surgery has largely replaced the use of ICRS for myopia due to the excellent outcomes, there may still be a role for ICRS for the treatment of low

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Corneal inlay implantation complicated by infectious keratitis

Cited by 26 publications

References 28 publications

A Review of Presbyopia Treatment with Corneal Inlays

A Review of Presbyopia Treatment with Corneal Inlays

Six-month visual outcomes for the correction of presbyopia using a small-aperture corneal inlay: single-site experience

Complications of Intracorneal Implants in Refractive Surgery

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