Flattening the curve: manual method for corneal allogenic intrastromal ring segment implantation

Parker, Jack; Dockery, Philip W.; Parker, John S.

doi:10.1097/j.jcrs.0000000000000555

Cited by 13 publications

(8 citation statements)

References 10 publications

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“…International BV) to improve their visualization and described a manual technique for channel creation in cases where FSL is not accessible. 6,7 Air drying the CAIRSs for 20 minutes has been shown to temporarily thin the segments, approximately corresponding to the water content of a dehydrated normal stroma, making their intrastromal implantation easier. 8,9 This technique decreases thickness and increases tissue stiffness, facilitating manipulation.…”

Section: Discussionmentioning

confidence: 99%

“…The obtained annulus is placed on a flat, well-spread sheet and allowed to air dry 20 minutes, following a previously reported method (Figure 1, D). 7 The thickness and width of the CAIRSs were analyzed in 4 quadrants using the Optovue Avanti Widefield Optical Coherence Tomography (OCT) system (Clarion Medical Technologies) (Figure 2). To ensure consistency in measurements, both the vertical and horizontal meridians were systematically chosen for assessment across all CAIRS cases.…”

Section: Surgical Techniquementioning

confidence: 99%

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Technique of corneal allogenic ring segment preparation using femtosecond laser: preclinical study on human corneal grafts

Mechleb,

Flamant,

Panthier

et al. 2024

J Cataract Refract Surg

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Purpose - This study aims to describe a novel technique for preparing Corneal Allogenic Ring Segments (CAIRS) using femtosecond laser (FSL) technology. Setting - Hospital Foundation Adolphe de Rothschild- Noémie de Rothschild institute. Design - Pre-clinical study conducted on human corneal grafts. Methods - The corneal grafts were mounted on an artificial chamber pressurized (ACP) with preset constant pressure, and the femtosecond laser was used to create a circular annulus with specific dimensions. The resulting CAIRS were analyzed for their thickness and width after air drying. Results: A total of 25 CAIRS were prepared using the femtosecond laser. The mean width and thickness of the CAIRS were 803 ± 77 μm and 83 ± 16 μm, respectively. Statistical analysis revealed no significant differences in width among the various quadrants of each CAIRS or between different CAIRS. Significantly thicker CAIRS were obtained with higher ACP pressure. Conclusion: The technique of CAIRS preparation using femtosecond laser technology and controlled artificial anterior chamber (AAC) pressure demonstrated reproducibility and precision. This approach holds the potential for customizing and personalizing CAIRS based on individual corneal characteristics.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Technique of corneal allogenic ring segment preparation using femtosecond laser: preclinical study on human corneal grafts

Mechleb,

Flamant,

Panthier

et al. 2024

J Cataract Refract Surg

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“…CAIRS are becoming more widely adopted around the world [4][5][6][7][8][9] as a treatment for keratoconus and other corneal ectasias. It can be implanted in the form of segments or FIGURE 1.…”

Section: Discussionmentioning

confidence: 99%

Bowman Layer Marking for Correct Placement of Corneal Allogeneic Intrastromal Ring Segments

Jacob,

Agarwal,

Awwad

et al. 2023

Cornea

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Corneal allogenic intrastromal ring segments (CAIRS) refer to the placement of allogenic rings and segments in intrastromal channels within the cornea. Currently, a deepithelialized donor cornea is used as the allogenic source for CAIRS and the cut ring is turned sideways and implanted so that the thickness can be varied by varying the distance between the concentric trephine blades. In addition, to obtain a greater effect, CAIRSs are preferred to be implanted with the Bowman layer (BL) facing the corneal apex and posterior stroma facing limbally. Being flexible tissue, it is, however, important to prevent twisting and to maintain correct orientation. We describe a simple technique of marking the BL with a gentian violet surgical marker to simplify CAIRS insertion. BL marking allows easy visibility of twists and helps identify improper orientation, thus allowing correct insertion of CAIRS.

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“…Corneal allogenic intrastromal ring segments (CAIRS)[ 1 ] was first performed in 2015, and as described by us, refers to the intracorneal placement of ring segments of allogenic tissue of any source such as fresh cut segments, unprocessed, processed, preserved, or packaged segments. [ 1 ] These are being performed with greater frequency[ 2 3 4 5 6 7 8 9 10 ] because of the refractive and topographic effects they provide similar to but with greater range of effect than with synthetic intracorneal ring segments (ICRS). The allogeneic nature also decreases the risk of complications such as overlying melt, necrosis, intrusion, extrusion, and migration.…”

mentioning

confidence: 99%

Customized corneal allogenic intrastromal ring segments (CAIRS) for keratoconus with decentered asymmetric cone

Jacob,

Agarwal,

Awwad

et al. 2023

Indian Journal of Ophthalmology

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Corneal allogenic intrastromal ring segments (CAIRS) refer to the intracorneal placement of fresh, unprocessed, processed, preserved, or packaged allogenic rings/segments of any type/length. We described uniform-thickness CAIRS previously. We now describe a new technique of customized CAIRS to personalize the flattening effect as per individual topography. A prospective interventional case series of patients with pericentral/ paracentral decentered cones and gradation of keratometry with one side steeper than the other was conducted. Individually customized tapered CAIRS with variable volume, arc length, taper length, and gradient of taper were implanted. In total, 32 eyes of 29 patients with at least 1-year follow-up were included. Special double-bladed trephines and a CAIRS customizer template allowed the creation of individually customized CAIRS. Mean uncorrected distance visual acuity (UDVA) and spectacle-corrected distance visual acuity improved from 0.22 to 0.47 (P = 0.000) and from 0.76 to 0.89 (P = 0.001), respectively. Significant improvement was seen in K1, K2, Km, Kmax, topographic astigmatism, Q-value, sphere, cylinder, spherical equivalent, Root Mean Square (RMS), Higher Order Aberrations (HOA), and vertical coma (P < 0.01, 0.05). There was no significant change in the width or height of CAIRS between 1 month and last visit on anterior-segment optical coherence tomography. Five eyes continued to remain at the same UDVA, 27 eyes had at least 2 lines, and 13 eyes had at least 3 or more lines improvement in UDVA. The maximum improvement in UDVA was 7 lines. A significant difference in flattening was obtained at different zones across the tapered CAIRS. Thus, differential flattening was achieved across the cone based on the customization plan. Personalized customization was possible for each cornea, unlike limited models of progressive-thickness synthetic segments. Allogenic nature, greater customizability, efficacy, and absent need for large inventories are advantages compared to synthetic segments.

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Flattening the curve: manual method for corneal allogenic intrastromal ring segment implantation

Cited by 13 publications

References 10 publications

Technique of corneal allogenic ring segment preparation using femtosecond laser: preclinical study on human corneal grafts

Technique of corneal allogenic ring segment preparation using femtosecond laser: preclinical study on human corneal grafts

Bowman Layer Marking for Correct Placement of Corneal Allogeneic Intrastromal Ring Segments

Customized corneal allogenic intrastromal ring segments (CAIRS) for keratoconus with decentered asymmetric cone

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