Corneal surgery in keratoconus: which type, which technique, which outcomes?

Arnalich‐Montiel, Francisco; Barrio, Jorge L. Alió del; Alió, Jorge L.

doi:10.1186/s40662-016-0033-y

Cited by 104 publications

(83 citation statements)

References 94 publications

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“…More importantly, the porcine cornea has an abundant source and can be acquired easier and cheaper than synthetic scaffolds. Deep lamellar keratoplasty (DLK) is a safe alternative to penetrating keratoplasty (PK) for common diseases such as keratoconus due to the similar corrected visual acuity, refractive results, and complication rates between DLK and PK[5, 40, 41]. Moreover, the risk of endothelial rejection can be avoided[42].…”

Section: Discussionmentioning

confidence: 99%

“…The most successful and widely used treatment for corneal blindness is transplantation with human donor corneal tissue in several procedures such as penetrating keratoplasty [3], anterior lamellar keratoplasty (ALK) or deep ALK (DALK)[4, 5]. However, there is a severe shortage of acceptable donor corneal tissue, especially in developing countries [6].…”

Section: Introductionmentioning

confidence: 99%

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Three-Dimensional Construction of a Rabbit Anterior Corneal Replacement for Lamellar Keratoplasty

Pang

Zhang

et al. 2016

PLoS ONE

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The aim of this study was to construct a rabbit anterior corneal replacement for transplantation using acellular porcine corneal matrix (APCM) and rabbit epithelial or stromal cells. APCM was prepared from fresh porcine cornea treated with 0.5% (wt./vol.) sodium dodecyl sulfate (SDS) solution. The expanded stromal cells were first injected into APCM parallel to its surface and were cultured in a shaking culture system for 7 days to obtain the stromal construct. Next, corneal epithelial cells were cultured on the stromal construct surface for another 7 days to obtain rabbit anterior corneal lamella. The construct had a phenotype similar to that of normal cornea, with high expression of cytokeratin 3 in the epithelial cell layer and vimentin in the stromal cells. More importantly, the construct integrated well with the implanted host corneal tissue, and the implant cornea maintained transparency in the 6-month follow-up, although there was a slight haze in the central corneal area. The endothelium in the surgery cornea had a similar cell density and mosaic pattern with normal cornea as shown by confocal laser corneal microscopy, and the regenerated corneal epithelial cells on the implant surface showed a similar morphology to that of natural epithelial cells. These results demonstrate that the constructed anterior corneal replacement exhibits an excellent biological property for lamellar keratoplasty and might be a possible alternative to human corneal tissue in the future.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Three-Dimensional Construction of a Rabbit Anterior Corneal Replacement for Lamellar Keratoplasty

Pang

Zhang

et al. 2016

PLoS ONE

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“…In its advanced stages, deep lamellar keratoplasty and penetrating keratoplasty (PK) are considered. However, potential complications and technical challenges raised the need for an alternative [3,4].…”

Section: Introductionmentioning

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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“…Due to a variety of factors and because of its associations with syndromes such as Down syndrome, Alport syndrome, and Ehlers-Danlos, keratoconus patients often develop lens opacity and visually disturbing cataracts (2,3). In such cases proper therapeutic decision should be made and that includes selection of the type of surgery, intraocular implants and postoperative optical management (4,5). Considering that keratoconus is endemic for the Balkans, eye care professionals must be alert not only when they operate on patients with established keratoconus but must also screen for forme fruste especially when cataract surgery is performed mainly as a standard refractive procedure.…”

Section: Introductionmentioning

confidence: 99%

Keratoconus must be diagnosed in advance. Case report and discussion of the diagnostic approach

Grupchev

Marinov

Manolova

2017

SSM

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Performing cataract surgery on a patient with keratoconus is not uncommon. Cataract surgery for such patients does require some additional testing and consideration for the best visual outcomes. Choosing the appropriate lens and lens power can be more challenging. Most patients with keratoconus have high negative spherical aberration and implantation of multifocal intraocular lenses (IOLs) will result in the loss of contrast sensitivity associated with these lenses, which will be magnified by the corneal irregularity. Also, decentration of IOLs relative to the apex of the cone will induce coma and decrease the quality of vision. Our goal was to describe the result after implantation of a multifocal intraocular lens in a patient with forme fruste keratoconus and to show that the preoperative selection of an appropriate IOL in such patients is the key for better visual function.

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Corneal surgery in keratoconus: which type, which technique, which outcomes?

Cited by 104 publications

References 94 publications

Three-Dimensional Construction of a Rabbit Anterior Corneal Replacement for Lamellar Keratoplasty

Three-Dimensional Construction of a Rabbit Anterior Corneal Replacement for Lamellar Keratoplasty

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

Keratoconus must be diagnosed in advance. Case report and discussion of the diagnostic approach

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