Combined Corneal Cross-Linking and Myoring Implantation in Advanced Keratoconus: Femtosecond Laser versus Manual Dissection

Background. Intrastromal corneal ring segments are widely adopted for keratoconus management. However, the complete ring (Myoring) was proposed to be superior in advanced cases. Myoring can be implanted either via femtoassisted or manual dissection techniques. A comparison between both techniques can delineate any differences in the outcomes. Methods. This was a prospective interventional case series study. Sixty-four eyes with progressive advanced keratoconus were enrolled: 36 and 28 had femtoassisted or manual Myoring, respectively. Uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), maximal keratometry (Kmax), spherical equivalent (SE) and corneal thinnest location were measured in all eyes preoperatively and at one, six, and 12 months postoperatively. Epi-off corneal cross-linking (CXL) was performed eight weeks after Myoring implantation for all cases. Results. Femtoassisted Myoring dissection significantly improved UCVA and CDVA from 0.1 ± 0.06 and 0.18 ± 0.1 preoperatively to 0.29 ± 0.08 and 0.43 ± 0.1 at 12 months. Also, manual technique similarly enhanced UCVA and CDVA from 0.11 ± 0.05 and 0.2 ± 0.1 preoperatively to 0.27 ± 0.2 and 0.4 ± 0.2 at 12 months. In terms of safety, while no cases of ring extrusion were encountered with the femtoassisted technique, six (21.4%) cases of extrusion were encountered in the manual group. Conclusion. Femtoassisted or manual Myoring technique followed by CXL is an effective choice for advanced progressive keratoconus. Although it did not reach a statistical significance, the high extrusion rate with manual dissection is a red flag to be considered.

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Primary Outcomes of Accelerated Epithelium-Off Corneal Cross-Linking in Progressive Keratoconus in Children: A 1-Year Prospective Study

Journal of Ophthalmology ◽

10.1155/2017/1923161 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Sherif A. Eissa ◽

Nashwa Badr Eldin ◽

Ashraf Ahmed Nossair ◽

Wael Ahmed Ewais

Keyword(s):

Visual Acuity ◽

Case Series ◽

Cross Linking ◽

Corneal Densitometry ◽

Corrected Distance Visual Acuity ◽

Uncorrected Visual Acuity ◽

Concentric Zone ◽

Baseline Values ◽

The Mean

Purpose. To evaluate corneal transparency following accelerated collagen cross-linking (ACXL) in pediatric keratoconus.Design. A prospective interventional case series.Methods. This study included 47 eyes (25 patients), aged 9–14 years, with documented progressive keratoconus. After applying 0.1% riboflavin drops, ACXL was performed. Assessment included corrected distance visual acuity (CDVA), uncorrected visual acuity (UCVA), corneal haze, and corneal densitometry in grayscale units (GSU).Result. The mean baseline and corneal densitometry peaked at 3 months post-ACXL while central and posterior densitometry showed a statistically significant increase (P<0.05) and peaked at 8 months postoperatively. By 12 months, densitometry in all corneal layers (P≥0.99) and concentric zones (P≥0.97) reached near baseline values. Slit-lamp graded haze peaked at 1 month to 1.82 ± 0.65 (P<0.05) and declined to near baseline at 12 months (0.39 ± 0.58). There was a statistically significant increase in the mean UCVA and CDVA at 12 months.Conclusion. Total and anterior corneal densitometry peaked after 3 months, while central and posterior densitometry peaked after 8 months. Maximum haze was at 1 month post-ACXL. All corneal layers, concentric zone densitometry and haze reached near baseline values after 1 year. Scheimpflug densitometry showed weak correlation with CDVA over the 12-month follow-up period (r=−0.193).

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Corneal Cross-Linking for Progressive Keratoconus in Children: Our Experience

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1009 ◽

2012 ◽

Vol 1 (1) ◽

pp. 53-56 ◽

Cited By ~ 12

Author(s):

Erez Bakshi ◽

Yaniv Barkana ◽

Yakov Goldich ◽

Isaac Avni ◽

David Zadok

Keyword(s):

Visual Acuity ◽

Medical Center ◽

Statistical Significance ◽

Cross Linking ◽

Long Term Stability ◽

Corrected Visual Acuity ◽

Department Of Ophthalmology ◽

Manifest Refraction ◽

Uncorrected Visual Acuity

ABSTRACT Purpose To assess the effect of corneal cross-linking on progressive keratoconus in children. Method In this retrospective study we enrolled nine eyes of nine consecutive children aged 11 to 17 years old who underwent corneal riboflavin-UVA induced cross-linking for progressive keratoconus at the Department of Ophthalmology at Assaf Harofeh Medical Center. They were followed for 6 to 24 months (average 16 ± 8.1 months). Evaluated parameters were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, pachymetry, slit lamp examination and corneal topography. Results Cross-linking resulted in stability of visual acuity in seven of the nine (77.8%) treated eyes. We found a nonsignificant improvement in UCVA and BSCVA with a small reduction of manifest cylinder. Furthermore, there was an improvement in spherical equivalent that was close to statistical significance (p = 0.07). There was 0.86 D reduction of average Kmax value postoperatively (p = 0.36). Most patients (7 of 9, 77.8%) showed a long-term stability or reduction in Kmax. Conclusion In this study, we demonstrated the efficacy of corneal cross-linking in arresting the progression of keratoconus in children. We believe that larger scale studies in this age group should be performed to further establish the relevance of this technique in children. How to cite this article Bakshi E, Barkana Y, Goldich Y, Avni I, Zadok D. Corneal Cross-Linking for Progressive Keratoconus in Children Our Experience. Int J Keratoco Ectatic Corneal Dis 2012;1(1):53-56.

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Long-term visual, anterior and posterior corneal changes after crosslinking for progressive keratoconus

European Journal of Ophthalmology ◽

10.1177/11206721211052878 ◽

2021 ◽

pp. 112067212110528

Author(s):

Abdelrahman Salman ◽

Ali Ali ◽

Shaaban Rafea ◽

Rana Omran ◽

Buraa Kubaisi ◽

...

Keyword(s):

Visual Acuity ◽

Statistical Significance ◽

Corneal Thickness ◽

Cross Linking ◽

Long Term Outcomes ◽

Corrected Distance Visual Acuity ◽

Hyperopic Shift ◽

The Mean

Aim To evaluate the long-term outcomes of corneal cross-linking (CXL) in patients with progressive keratoconus. Method In this retrospective non-comparative study, forty-five eyes of 31 patients with progressive keratoconus were treated with 30 min “epi-off” corneal cross-linking. The visual, refractive, topographic and tomographic outcomes were evaluated preoperatively and at least 10 years after cross-linking. Results Ten years post-corneal cross-linking, the mean anterior maximum keratometry decreased (−2.10 ± 3.25 D, P = 0.0001). Conversely, the posterior maximum keratometry increased (6.38 ± 9.79 D, P = 0.065). Both uncorrected and corrected distance visual acuity improved (LogMAR −0.08 ± 0.30) and (LogMAR −0.05 ± 0.21), respectively (P > 0.05, both). A statistically significant hyperopic shift was observed postoperatively (0.70 ± 1.31 D, P = 0.0009). The anterior topographic cylinder values revealed no change (−0.17 ± 1.31 D, P = 0.3), whereas the mean posterior cylinder values decreased (absolute value increased) significantly compared to baseline from −1.31 ± 0.97 D to −1.82 ± 1.78 D, (P < 0.05). The minimum corneal thickness values decreased significantly (−35.11 ± 48.63 µm, P = 0.0001). Four eyes (8.8%) showed more than 1 D increase in the anterior maximum keratometry. Conclusion This protocol and duration of Epi-off corneal cross-linking was found to be effective in halting keratoconus progression over the follow up period (10 years). Anterior corneal flattening and a hyperopic shift were observed. A statistically significant increase in the posterior corneal cylinder was observed. Although, not reaching statistical significance, the logMAR uncorrected and corrected visual acuity were improved.

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Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking

International Journal of Keratoconus and Ectatic Corneal Diseases ◽

10.5005/jp-journals-10025-1128 ◽

2016 ◽

Vol 5 (3) ◽

pp. 93-98 ◽

Cited By ~ 1

Author(s):

Rafael J Pérez-Cambrodí ◽

Pedro Ruiz-Fortes ◽

Alberto Artola

Keyword(s):

Visual Acuity ◽

Clinical Outcomes ◽

Statistical Significance ◽

Cross Linking ◽

Corneal Ectasia ◽

Significant Difference ◽

Corrected Distance Visual Acuity ◽

The Mean

ABSTRACT Objective To assess the clinical outcomes in ectatic corneas following accelerated transepithelial cross-linking (CXL) over 1 year of follow-up. Materials and methods Twenty-one eyes diagnosed with progressive corneal ectasia (19 keratoconus, 2 post-laser in situ keratomileusis ectasias) in 14 patients aged between 26 and 69 years were enrolled. All cases were treated with accelerated transepithelial CXL using the Avedro KXL® system (Waltham, MA, United States). Changes at visual, refractive, corneal topographic, and corneal aberrometric level were evaluated over a 12-month follow-up period. The demarcation was also determined using optical coherence tomography (OCT). Results The mean depth of the demarcation line measured by OCT was 202.72 µm, varying between 153 and 230 µm. One month postsurgery, a change was noted at the limit of statistical significance in sphere (p = 0.05) and in spherical equivalent (p = 0.05). Likewise, a statistically significant difference was observed in corrected distance visual acuity (CDVA) (p = 0.01). There were no significant changes in either visual acuity or refraction between 1 and 6 months (p ≥ 0.35). Although changes in trend were observed in corneal topographic and aberrometric parameters after surgery, none reached statistical significance (p ≥ 0.08). A significant change was observed only in astigmatism of the posterior surface between 1 and 12 months (p = 0.02). Conclusion Accelerated transepithelial CXL may be a useful technique for the management of progressive corneal ectasia, as it is able to maintain the topographic and aberrometric profile of the cornea with no significant changes. Longer-term studies are required to confirm this finding How to cite this article Piñero DP, Artola A, Ruiz-Fortes P, Soto-Negro R, Pérez-Cambrodi RJ. Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking. Int J Kerat Ect Cor Dis 2016;5(3):93-98.

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Accelerated versus Standard Corneal Cross-linking for Progressive Keratoconus in Syria

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v16i3.9430 ◽

2021 ◽

Author(s):

Abdelrahman M Salman ◽

Taym R Darwish ◽

Yusra H Haddad ◽

Rafea H Shabaan ◽

Mohammad Z Askar

Keyword(s):

Visual Acuity ◽

Spherical Aberration ◽

Statistical Significance ◽

Corneal Thickness ◽

Cross Linking ◽

Standard Protocol ◽

Corrected Distance Visual Acuity ◽

Retrospective Comparative Study ◽

Accelerated Protocol ◽

Corneal Tomography

Purpose: To compare the outcomes of accelerated versus standard corneal cross-linking for the treatment of progressive keratoconus. Methods: In this retrospective comparative study, 63 eyes of 40 patients with progressive keratoconus were divided into two groups; 27 eyes in group one were treated with an accelerated protocol (10 mW/cm2, 9 min) and 36 eyes in group two were treated with the standard method (3 mW/cm2, 30 min). Visual acuity, refraction, corneal topography, corneal tomography, and anterior and posterior corneal higher-order aberrations (HOAs) were assessed preoperatively and 18–30 months postoperatively. Results: The LogMAR uncorrected and corrected distance visual acuity values were improved in both groups postoperatively. However, the improvement was significantly higher in group one (P < 0.05, all). The flattening in the anterior keratometry readings, flat K, steep K, and average K were significantly higher in group two (P < 0.001, all). The maximum anterior keratometry (AKf) values significantly decreased in both groups, whereas the maximum posterior keratometry (AKb) values increased. The reduction in the minimum corneal thickness (ThKmin) was significantly greater (36.49um) in group two, compared to 10.85um in group one. There was a significant increase in the posterior average keratometry, and a significant decrease in the posterior astigmatism, along 3 mm meridian in S-CXL (P = 0.03, P = 0.008, respectively), while the corresponding values showed no statistical significance in group one (P > 0.05). The anterior corneal trefoil was significantly reduced in group one (P = 0.002), whereas anterior total HOAs and coma were significantly improved in group two (P < 0.0014, all). The posterior corneal spherical aberration decreased significantly in group one (P = 0.02), while group two revealed significant reduction in the posterior trefoil values (P = 0.011). The change in the anterior maximum keratometry was significantly and positively correlated to the preoperative maximum keratometry in group two (P = 0.53, P = 0.003). Conclusion: An accelerated cross-linking protocol using 10 mW/cm2 for 9 min showed more visual improvement and less pachymetric reduction when compared to the standard protocol, however, anterior corneal flattening, posterior corneal steepening, and the change in the posterior astigmatism were significantly higher in the standard protocol; while corneal HOAs were improved in both protocols.

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Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens.

10.21203/rs.3.rs-364268/v1 ◽

2021 ◽

Author(s):

Luis Arrevola-Velasco ◽

Jaime Beltrán ◽

Maria Jesus Gimeno ◽

Julio Ortega-Usobiaga ◽

Vasyl Druchkiv ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Lens ◽

Epiretinal Membrane ◽

Case Series ◽

Primary Outcome Measure ◽

Retrospective Case ◽

Visual Outcomes ◽

Case Series Study ◽

Trifocal Iol ◽

Corrected Distance Visual Acuity

Abstract Purpose: To evaluate the effect on visual outcomes of a diffractive trifocal intraocular lens (IOL) in pars plana vitrectomy (PPV) for removal of epiretinal membrane (ERM) in pseudophakic eyes. Methods: This is retrospective case-series study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Other outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). Results: Mean corrected distance visual acuity (CDVA) was 0.03±0.03 logMAR after phacoemulsification; this worsened to 0.23±0.10 logMAR with ERM, improving to 0.10±0.04 log MAR 12 months after PPV (p=0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62±0.51 after lensectomy. This worsened to Jaeger 5.46±1.67 with ERM and improved to the initial Jaeger 2.69±0.84 after PPV (p=0.005). CMT decreased significantly, from 380.15 ±60.50 µm with the ERM to 313.70 ±36.98 µm after PPV. Mean SE after lensectomy was -0.18 ±0.38 D, which minimally changed to – 0.18±0.47 D after PPV (p=0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. Conclusion: PPV for ERM in eyes with this trifocal IOL is safe and effective, and allows recovery of the loss of UNVA.

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Ferrara Rings for Visual Rehabilitation in Eyes with Keratoconus and Previous Cross-Linking Using the Ferrara Ring Nomogram

Vision ◽

10.3390/vision5040045 ◽

2021 ◽

Vol 5 (4) ◽

pp. 45

Author(s):

Cameron A. McLintock ◽

James McKelvie ◽

Ye Li ◽

Samer Hamada ◽

Damian Lake

Keyword(s):

Visual Acuity ◽

Case Series ◽

Cross Linking ◽

Visual Rehabilitation ◽

Queen Victoria ◽

Intrastromal Corneal Ring ◽

Uncorrected Visual Acuity ◽

History Of ◽

Corneal Collagen ◽

Corneal Tomography

Purpose: To report the visual, refractive and tomographic outcomes following the implantation of intrastromal corneal ring segments (ICRS) (Ferrara rings, AJL Ophthalmics, Miñano, Spain) in eyes with a history of keratoconus and corneal cross-linking using the Ferrara ring nomogram. Methods: Retrospective, interventional case series performed at the Corneoplastics Unit, Queen Victoria Hospital, East Grinstead, United Kingdom. Results: 21 eyes of 19 patients with a history of keratoconus and prior corneal collagen cross-linking had Ferrara Intrastromal Corneal Ring Segments implanted between December 2015 and October 2017. The number, thickness and length of ring segments was chosen based on the Ferrara ring company nomogram. Mean uncorrected visual acuity (UDVA) improved from 0.88 to 0.52 logMAR (p < 0.001). Mean corrected visual acuity (CDVA) improved from 0.47 to 0.36 logMAR (p = 0.046). The percentage of eyes achieving 20/40 UDVA and CDVA increased from 5% to 38% and from 38% to 67%, respectively. Of the eyes, 52.3% gained at least two lines of CDVA. The spherical equivalent improved from −7.51D to −3.76D (p < 0.001) and the refractive astigmatism magnitude improved from 5.14D to 2.76D (p = 0.004). There were significant improvements in the corneal tomography with mean keratometry (KM) improving from 50.40D (3.53) to 48.24D (3.00) (p = 0.01) and keratometric astigmatism magnitude improving from 5.14D (2.91) to 2.76D (1.67) (p = 0.004). Conclusion: Insertion of Ferrara rings in keratoconic eyes with a history of prior cross-linking using the company nomogram results in significant improvements in visual, refractive and tomographic outcomes.

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Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber

Ophthalmology and Eye Diseases ◽

10.4137/oed.s12672 ◽

2013 ◽

Vol 5 ◽

pp. OED.S12672

Author(s):

Kagmeni Giles ◽

Moukouri Ernest ◽

Domngang Christelle ◽

Nguefack-Tsague Georges ◽

Cheuteu Raoul ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Teaching Hospital ◽

Case Series ◽

University Teaching ◽

Case Series Study ◽

The Mean ◽

The University

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.

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Visual Quality Assessment of Posterior Capsule Opacification Using Optical Quality Analysis System (OQAS)

Journal of Ophthalmology ◽

10.1155/2017/9852195 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Hui Zhang ◽

Jing Wang

Keyword(s):

Visual Acuity ◽

Quality Assessment ◽

Case Series ◽

Optical Quality ◽

Posterior Capsule Opacification ◽

Assessment System ◽

Quality Analysis ◽

Posterior Capsule ◽

Case Series Study ◽

Visual Disturbances

Objective. To evaluate intraocular scattering in eyes with posterior capsule opacification by means of an objective scatter index (OSI) obtained from double-pass images of optical quality assessment system (OQAS TM II) and to determine the indication for laser capsulotomy when patients report visual disturbances without decreased visual acuity. Methods. In this prospective, observational, and nonconsecutive case series study, a total of 32 eyes of 29 patients are diagnosed with posterior capsule opacification after age-associated cataract were analyzed. Patient examination included age, the period after cataract surgery, logMAR best corrected visual acuity (BCVA), and OSI. Results. We found a significant decrease in the BCVA and increase in the OSI with the development of posterior capsule opacification. The decrease of BCVA was statistically correlated with the increase of OSI (r=0.812, P<0.01). In patients who reported visual disturbances without decreased visual acuity, OSI decreased to <1.3 and subjective symptoms were resolved in all cases although there was no significant improvement in visual acuity after laser capsulotomy. Conclusions. The results of our study showed that OSI is also a useful parameter for objectively evaluating posterior capsule opacification. OSI may help predict laser capsulotomy in patients who report visual disturbances without decreased visual acuity.

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Frequency of Complications Following Cataract Surgery in Diabetic Patients at Tertiary Care Hospital

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.9-1.157 ◽

2022 ◽

Vol 9 (1) ◽

pp. 75-81

Author(s):

Muhammad Bilal ◽

Shafqat Ali Shah ◽

Marina Murad ◽

Saad Ali ◽

Ammad Ali ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Tertiary Care ◽

Case Series ◽

Female Gender ◽

Posterior Capsule Opacification ◽

Posterior Capsule ◽

Diabetic Patients ◽

Care Hospital ◽

Case Series Study

OBJECTIVES: To determine the frequency of complications following cataract surgery in diabetic patients admitted in the ophthalmology unit. METHODOLOGY: A prospective descriptive interventional case series study was conducted after approval of the ethical committee, from June 2017-June 2020 at the Ophthalmology department MTI-MMC. A total of 129 patients from either gender were enrolled in study. All the study patients went through detailed history and complete ocular examination. After necessary investigations, surgical procedure was carried out. Results were analyzed through the SPSS-24 version. RESULTS: Out of the total 129 eyes of the diabetic patients, fifty-nine (45.7%) were males and seventy (54.3%) were females with a ratio of 1:1.2. Uveitis leads the chart in complications found in twenty (15.50%) eyes while PODR being the least common found in only ten (7.75%) eyes. Worse visual acuity was observed in fourteen (10.85%) eyes. Striate keratopathy and posterior capsule opacification were found in sixteen (12.40%) and fifteen (11.62%) eyes respectively. Among the patients, 15.7% were having more than one complication during follow-up visits and eighty-eight (68.2%) eyes were found to have none complication. The age group 51-60 years observed frequent complications as compared to other groups. Similarly female gender (38.57%) has frequent complications as compared to males (2.7%). CONCLUSION: The study concludes Uveitis as the most common complication observed in 15.50% 0f the eyes while worse visual acuity (10.85%) and progression of diabetic retinopathy (7.75%) being the least common. Striate keratopathy was found in 12.40% while posterior capsule opacification in 11.62% of the eyes.

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