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

Background. To evaluate the change in corneal astigmatism after intrastromal corneal ring segment (ICRS) implantation in keratoconus patients with previous deep anterior lamellar keratoplasty (DALK). Design was a longitudinal, retrospective, interventional study. The study included 25 eyes of 24 patients with keratoconus who had DALK performed at least two years prior to ICRS implantation. All patients had a clear corneal graft with up to 8.00 D of corneal astigmatism and intolerance to contact lenses. The studied parameters were age, sex, corrected distance visual acuity (CDVA), maximum keratometry (K1), minimum keratometry (K2), spherical equivalent, and astigmatism. There was a statistically significant decrease in the postintervention analysis as follows: 3.5 D reduction in K1 (p<0.001); 1.53 D in K2 (p=0.005); and 2.52 D (p<0.001) in the average K. The spherical equivalent reduced from −3.67 D (±2.74) to −0.71 D (±2.35) (p<0.001). The topographic astigmatism reduced from 3.87 D preoperatively to 1.90 D postoperatively (p<0.001). The CDVA improved from 0.33 (±0.10) to 0.20 (±0.09, p<0.001). ICRS implantation is a useful option for the correction of astigmatism after DALK as it yields significant visual, topographic, and refractive results.

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Keratoconus Treatment Toolbox: An Update

10.5772/intechopen.94854 ◽

2020 ◽

Author(s):

Vatookarn Roongpoovapatr ◽

Mohamed Abou Shousha ◽

Puwat Charukamnoetkanok

Keyword(s):

Penetrating Keratoplasty ◽

Treatment Options ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Visual Rehabilitation ◽

Intrastromal Corneal Ring ◽

Anterior Lamellar Keratoplasty ◽

Corneal Scar ◽

Ring Segment ◽

Collagen Cross Linking

Keratoconus is a bilateral, asymmetric, progressive disease of the cornea which can lead to visual impairment and blindness as irregular astigmatism increases and corneal scar occurs. Currently, many methods are available for a treatment of keratoconus. The treatment can help enhance visual rehabilitation and prevent progression in keratoconus patients. The treatment options included non-surgical and surgical managements. This review offers a summary of the current and emerging treatment options for keratoconus- eyeglasses, contact lens, corneal collagen cross-linking (CXL), CXL Plus, intrastromal corneal ring segment (ICRS), Corneal Allogenic Intrastromal Ring Segments (CAIRS), Penetrating Keratoplasty (PK), Deep Anterior Lamellar Keratoplasty (DALK), Bowman layer transplantation (BL transplantation) and gene therapy.

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Deep Anterior Lamellar Keratoplasty in Eyes With Intrastromal Corneal Ring Segments

Cornea ◽

10.1097/ico.0000000000001906 ◽

2019 ◽

Vol 38 (5) ◽

pp. 642-644 ◽

Cited By ~ 2

Author(s):

Vittoria Ravera ◽

Cristina Bovone ◽

Vincenzo Scorcia ◽

Sergio DʼAngelo ◽

Massimo Busin

Keyword(s):

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Intrastromal Corneal Ring ◽

Anterior Lamellar Keratoplasty

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How to improve Visual Acuity after Intrastromal Corneal Ring Segments? Implantation for Keratoconus and Post-LASIK Ectasia

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1082 ◽

2014 ◽

Vol 3 (2) ◽

pp. 69-75 ◽

Cited By ~ 1

Author(s):

Ramez Barbara ◽

Adel Barbara

Keyword(s):

Visual Acuity ◽

Contact Lenses ◽

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Dry Eyes ◽

Intrastromal Corneal Ring ◽

Anterior Lamellar Keratoplasty ◽

Uncorrected Visual Acuity ◽

Long Term Follow Up ◽

Irregular Astigmatism

ABSTRACT Keratoconus (KC) is an ecstatic corneal disease that causes irregular astigmatism which cannot be corrected by glasses, the irregular astigmatism causes loss of visual acuity (VA) both the uncorrected and the corrected VA, in addition to deterioration in the quality of vision. Contact lenses (CLs) improve the VA but cannot be tolerated in many cases due to several causes, such as loss of motivation, atopic and allergic conjunctivitis that are more frequently associated with KC and dry eyes. Intrastromal corneal ring segments implanted in keratoconic eyes improve uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), reduce myopia, astigmatism, high order aberrations (HOA) and regularizes the cornea (less irregular astigmatism), similar results are achieved in the treatment of post-LASIK and post PRK ectasia. These results were confirmed in long-term follow-up. The more advanced the KC the more is the effect of the ICRS but the less the functional VA achieved and vice versa. Thicker rings are more effective, and the smaller the optical zone the more is the effect of the ICRS. The aim of ICRS implantation in KC is not to be free of glasses or CL but to enable the patient of seeing with glasses or to tolerate CL in order to prevent or delay the need for penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK). In many cases, we can achieve a functional and satisfactory UCVA with no need for glasses and this is the case in nonadvanced KC but not in the advanced cases. In some cases, the results achieved need additional means to improve VA in order to get satisfactory VA. There are nonsurgical and surgical means to improve VA after ICRS, these means will be reviewed in this article. How to cite this article Barbara A, Barbara R. How to improve Visual Acuity after Intrastromal Corneal Ring Segments? Implantation for Keratoconus and Post-LASIK Ectasia. Int J Kerat Ect Cor Dis 2014;3(2):69-75.

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