scholarly journals Intrastromal Corneal Ring Segments for Astigmatism Correction after Deep Anterior Lamellar Keratoplasty

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Júlio C. D. Arantes ◽  
Sandro Coscarelli ◽  
Paulo Ferrara ◽  
Luana P. N. Araújo ◽  
Marcos Ávila ◽  
...  
Keyword(s):  
Contact Lenses ◽  
Corneal Astigmatism ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Spherical Equivalent ◽  
Astigmatism Correction ◽  
Intrastromal Corneal Ring ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
Ring Segment

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.

Keratoconus Treatment Toolbox: An Update

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.

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

2014 ◽  
Vol 3 (2) ◽  
pp. 69-75 ◽  
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.

Outcomes of a 320-degree intrastromal corneal ring segment implantation for keratoconus: Results of a 6-month follow-up

2018 ◽  
Vol 30 (1) ◽  
pp. 139-146 ◽  
Author(s):  
Guilherme Andrade do Nascimento Rocha ◽  
Paulo Ferrara de Almeida Cunha ◽  
Leonardo Torquetti Costa ◽  
Luciene Barbosa de Sousa
Keyword(s):  
Visual Acuity ◽  
Spherical Equivalent ◽  
Distance Visual Acuity ◽  
Uncorrected Distance Visual Acuity ◽  
Intrastromal Corneal Ring ◽  
Corrected Distance Visual Acuity ◽  
Ring Segment ◽  
The Mean ◽  
Corneal Tomography

Importance: This study shows that a newer long-arc length intrastromal corneal ring segment is efficient and safe for keratoconus treatment. Background: To evaluate visual, tomographic results and complications of a 320-degree intrastromal corneal ring segment implantation with the femtosecond laser for keratoconus treatment. Design: A prospective, nonrandomized, and interventional study. Participants: A total of 34 eyes of 31 patients diagnosed with keratoconus were enrolled. Methods: Patients were divided into two groups based on the strategy used for 320-degree intrastromal corneal ring segment thickness selection. In one group, this selection was based on spherical equivalent (SE group) and in the other on the mean asphericity (Q group). The uncorrected and corrected distance visual acuities, spherical equivalent, K1, K2, Km, Kmax, and mean asphericity ( Q) on corneal tomography were evaluated preoperatively and at 3 and 6 months postoperatively. For astigmatism improvement, we analyzed the corneal tomographic vectorial astigmatism change preoperatively and at 6 months postoperatively. The mean follow-up period was 6.63 ± 0.96 months. Results: The mean uncorrected distance visual acuity and corrected distance visual acuity improved with a significant spherical equivalent improvement ( p < 0.05), with no differences between the 320-degree intrastromal corneal ring segment groups. All corneal tomographic parameters improved significantly ( p < 0.05) between the preoperative and postoperative intervals, with a significant better performance when we used spherical equivalent for the 320-degree intrastromal corneal ring segment thickness selection. Finally, the mean vectorial corneal tomographic astigmatism significantly improved after 6 months, again with no differences between groups. Conclusion: This study suggests that implanting a 320-degree intrastromal corneal ring segment is a safe and effective procedure for treating patients with keratoconus. It also suggests that for thickness selection spherical equivalent is the better strategy.

scholarly journals A New Pre-descemetic Corneal Ring (Neoring) in Deep Anterior Lamellar Keratoplasty for Moderate-Advanced Keratoconus: A Pilot 2-Year Long-Term Follow-Up Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Belén Alfonso-Bartolozzi ◽  
Carlos Lisa ◽  
Luis Fernández-Vega-Cueto ◽  
David Madrid-Costa ◽  
José F. Alfonso
Keyword(s):  
Spherical Aberration ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
Long Term Follow Up ◽  
The Mean ◽  
Corneal Tomography

Purpose: To assess the outcomes of implanting a new polymethylmethacrylate (PMMA) ring (Neoring; AJL Ophthalmic) in pre-descemet deep anterior lamellar keratoplasty (PD-DALK) procedure for moderate-advanced keratoconus.Methods: This prospective study included 10 eyes of 10 patients with moderate-advanced keratoconus who underwent PD-DALK with Neoring implantation. Neoring was implanted in a pre-descemetic pocket. The post-operative examination included refraction, corrected distance visual acuity (CDVA), corneal tomography, and endothelial cell density (ECD). The root mean squares (RMSs) for coma-like aberrations and spherical aberration were evaluated for a pupil size of 4.5 mm. The junctional graft (Tg) and host (Th) thicknesses were measured. The post-operative follow-up was 24 months.Results: Post-operative CDVA was 0.82 ± 0.14 (decimal scale), 100% of the eyes achieved a CDVA of 0.7 (decimal scale). The refractive cylinder was −2.86 ± 1.65 2-years after surgery. No eyes had a post-operative refractive cylinder ≥5.00 D and in five eyes (50%), it was ≤2.50 D. At the last visit, the mean keratometry was 45.64 ± 1.96 D, the RMS for coma-like aberrations was 0.30 ± 0.15 μm and spherical aberration was 0.22 ± 0.09. The mean ECD remains without changes over the follow-up (P = 0.07). At the last visit, Tg and Th were 679.9 ± 39.0 and 634.8 ± 41.2 μm, respectively. The thickness of the complex (host-Neoring) was 740.6 ± 35.6 μm. In all cases, this thickness was thicker than Tg.Conclusion: The results of this study suggest that PD-DALK along Neoring implantation is a viable, effective, and safe option to optimize the post-operative results for moderate-severe keratoconus.

scholarly journals Influence of scleral lenses on visual acuity and aberrations in patients with irregular cornea

The Eye ◽  
2019 ◽  
Vol 126 (2019-2) ◽  
pp. 32-39
Author(s):  
Olga Tikhonova ◽  
Nikolai Pashtaev ◽  
Nadezhda Pozdeyeva ◽  
Alexander Myagkov ◽  
Svetlana Bodrova ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Laser Surgery ◽  
Contact Lenses ◽  
Lens Space ◽  
Astigmatism Correction ◽  
Intrastromal Corneal Ring ◽  
Stable Vision ◽  
Ring Segment ◽  
Ophthalmologic Examination ◽  
Fitting In

Purpose: To analyze changes of functional parame¬ters and aberrations before fitting and after using rigid gas-permeable scleral lenses (RGPSCL) in patients with irregular cornea. Material and methods. 21 patients (29 eyes) with irregular astigmatism of various etiology were enrolled in this study. The patients could not achieve good visual aсuity in glasses, standard soft or rigid corneal contact lenses. Complex ophthalmologic examination was per¬formed: autorefractometry, visometry, biomicroscopy, computer corneal topography, aberrometry on “OPD-Scan II” (“Nidek”, Japan) before fitting scleral lenses and during the period of their wearing. Results and discussion. The results demonstrat¬ed significant visual acuity improvement after RGP¬SCL fitting in all observed patients. UCVA amounted to 0.1±0.18, BCVA in glasses amounted to 0.4±0.26, BCVA in RGPSCL amounted to 0.7±0.1. An increase of best-corrected visual acuity in RGPSCL was statistically significant in patients after keratoplasty, after intra-stromal corneal ring segments (ICRS) implantation, af¬ter refractive laser surgery (RLS) and in cases of mixed astigmatism. We have found that the correction of ker¬atoconus with the use of RGPSCL resulted in a decrease of the root mean square value (RMS), measured in the 3 mm and 5 mm zones by 2.5 times and 4 times, re¬spectively. In patients wearing RGPSCL after kerato¬plasty, statistically significant decrease in RMS was observed in the 3 mm zone (by 3.85 times) and in the 5 mm zone (by 2.99 times). In patients wearing RGPSCL after implantation of intrastromal corneal ring segment (ICRS), RMS in the 3 mm zone decreased by 1.5 times. In patients wearing RGPSCL after refractive laser surgery (RLS) RMS was 2.5 times lower in the 3 mm zone and 2.8 times lower in the 5 mm zone. In case of mixed astigmatism correction with RGPSCL, RMS increased by 1.6 times in the 3 mm zone and practically did not change in the 5 mm zone. Conclusion. The results obtained demonstrated significant visual acuity improvement in all observed patients. The sub-lens-space filled with tear forms a unified “cornea-tear-scleral contact lens” optic system that corrects unevenness of cornea, decreases amount of high-order aberrations (HOA) and provides a clear stable vision.

Deep Anterior Lamellar Keratoplasty in Eyes With Intrastromal Corneal Ring Segments

Cornea ◽  
2019 ◽  
Vol 38 (5) ◽  
pp. 642-644 ◽  
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

Avoiding big bubble complications: outcomes of layer-by-layer deep anterior lamellar keratoplasty in children

2018 ◽  
Vol 102 (8) ◽  
pp. 1103-1108 ◽  
Author(s):  
Uri Elbaz ◽  
Caitriona Kirwan ◽  
Carl Shen ◽  
Asim Ali
Keyword(s):  
Paediatric Population ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Lamellar Thickness ◽  
Layer By Layer ◽  
Safe Procedure ◽  
Anterior Lamellar Keratoplasty ◽  
Corrected Distance Visual Acuity ◽  
The Mean

Background/aimsTo describe the visual and clinical outcomes of manual layer-by-layer deep anterior lamellar keratoplasty (DALK) in a paediatric population.MethodsThe charts of all children who underwent DALK surgery between January 2007 and January 2015 were reviewed retrospectively. Data collected included preoperative and postoperative spectacle-corrected distance visual acuity (CDVA), intraoperative and postoperative complications including graft rejection and failure. Residual posterior lamellar thickness (RPLT) and endothelial cell density (ECD) were measured in eyes with follow-up longer than 6 months.ResultsFifty-one eyes of 42 patients were included in the study. The mean patient age at surgery was 11.2±5.2 years and the mean follow-up time was 36.5±23.7 months. The most common indications for surgery were mucopolysaccharidosis (29.4%) and keratoconus (23.5%). Nine eyes (17.6%) had intraoperative microperforation, none of which were converted to penetrating keratoplasty (PKP). Only one eye (2.0%) was converted to PKP. Five eyes (9.8%) had a stromal rejection episode of which one eye failed. Another four eyes (7.8%) experienced graft failure among which three eyes (75%) had infectious keratitis. Three of the five failed grafts had a successful repeat DALK. The average RPLT was 81.9±36.5μm. ECD was significantly lower in the operated eye compared with the normal eye (3096±333 cells/mm2 vs 3376±342 cells/mm2, n=11, P=0.003). The mean postoperative CDVA was 0.5±0.4 logarithm of the minimum angle of resolution (logMAR) reflecting a gain of 0.3 logMAR (P<0.001).ConclusionManual dissection DALK is a safe procedure in children with stromal opacities. Despite successful structural rehabilitation, functional recovery is still suboptimal mostly due to amblyopia.

scholarly journals Clinical Aspects of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Severe Ocular Complications in South Korea

2021 ◽  
Vol 8 ◽  
Author(s):  
Mee Kum Kim ◽  
Kyung Chul Yoon ◽  
Sook Hyun Yoon ◽  
Kyoung Yul Seo
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Contact Lenses ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Stevens Johnson Syndrome ◽  
Clinical Aspects ◽  
Prostaglandin E ◽  
Ocular Complications ◽  
Johnson Syndrome ◽  
Anterior Lamellar Keratoplasty

This review describes the current knowledge regarding genetic susceptibilities and treatment strategies for Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with ocular complications, in Korea. In a case-control study, the gene frequencies of both HLA-A*0206 (20.0%) and HLA-Cw*0304 (15.0%) increased but the gene frequency of HLA-Cw*0303 (1.3%) decreased with cold medicine (CM)-SJS/TEN with severe ocular complications (SOCs). In a case-series, positive genotyping of HLA-B*5801 was 80.0% in allopurinol-induced SJS/TEN without SOCs. In a genome-wide association study, HLA-A*0206 was substantially related to CM-SJS/TEN with SOCs. Both HLA-A*0206 and prostaglandin-E receptor 3 (PTGER3) single nucleotide polymorphism (SNP) rs1327464 exert a synergistic effect on SOCs in CM-SJS/TEN. In the acute stage, conventional procedures, amniotic membrane transplantation or suture-less amniotic contact lenses are applied. Applications of intravenous Immunoglobulin (IVIG) or mega-dose steroids are attempted in patients with high acute ocular and systemic involvement scores. In the chronic stage, keratolimbal transplantation and penetrating keratoplasty are the standard procedures. Either autologous nasal or oral mucosal grafts, or biomaterial-free cultured oral mucosal epithelial cell sheets are transplanted as alternative therapies. Deep anterior lamellar keratoplasty is attempted. Combined photodynamic therapy with intrastromal bevacizumab injection or intense pulse laser are used to resolve chronic ocular complication. Corneoscleral contact lenses are available for a visual rehabilitation. As a last resort, Seoul-type keratoprosthesis had been transplanted. There are unmet needs to standardize nationwide ocular grading system and to correct tarsal scarring using mucosal grafting. This review provides a perspective on the current practices to treat ocular complications in SJS/TEN.

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