scholarly journals Pre-Descemetic Placement of Intracorneal Ring Segments for Keratoconus after Mechanical Implantation

2021 ◽  
pp. 940-943
Author(s):  
Faady Yahya ◽  
Christian F. Prünte ◽  
Hendrik P.N. Scholl ◽  
Zisis Gatzioufas
Keyword(s):  
Visual Acuity ◽  
High Resolution ◽  
Femtosecond Laser ◽  
Anterior Segment ◽  
Slit Lamp ◽  
Anterior Segment Oct ◽  
Ring Segment ◽  
Intracorneal Ring Segment

We report the case of a 23-year-old male who was referred to our clinic for a routine follow-up examination. The patient was treated for keratoconus 3 years ago in Colombia, where intracorneal ring segments were implanted mechanically in both eyes to improve his visual acuity. Surprisingly, we discovered a pre-descemetic placement of intracorneal ring segments, which could lead to potential complications, under circumstances. We illustrate this impressive finding with slit-lamp photography and high-resolution anterior segment OCT and advocate for the use of femtosecond laser as the method of choice for intracorneal ring segment insertion in order to provide maximal precision and safety.

Unilateral Ectasia characterized by Advanced Diagnostic Tests

2016 ◽  
Vol 5 (1) ◽  
pp. 40-51 ◽  
Author(s):  
Bernardo Lopes ◽  
Marcella Q Salomão ◽  
Isaac C Ramos ◽  
Fernando Faria-Correia
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Diagnostic Tests ◽  
Diagnostic Methods ◽  
Distance Visual Acuity ◽  
Epithelial Thickness ◽  
Ring Segment ◽  
Intracorneal Ring Segment ◽  
The Right

ABSTRACT To describe a case of very asymmetric ectasia successfully treated by femtosecond laser-assisted intracorneal ring segment implantation, in which the diagnosis of unilateral ectasia in the right eye was based on the clinical findings including history, follow-up, and advanced diagnostic data. The patient's history was positive for ocular allergy with moderate- to-intense eye rubbing only in the right eye. The uncorrected distance visual acuity was 20/63 in the right eye and 20/32 in the left eye. The corrected distance visual acuity (CDVA) was 20/40 in the right eye (-1.75-4.00 × 35°) and 20/16 in the left eye (-0.50-0.25 × 115°). After femtosecond laser-assisted intracorneal ring segment implantation, the right eye improved CDVA to 20/20-1. Concerning ectasia/keratoconus diagnosis, the left eye remained stable over 1 year of follow-up with unremarkable topometric, tomographic, and biomechanical findings. Epithelial thickness mapping by spectral domain optical coherence tomography and very-high-frequency digital ultrasound demonstrated epithelial thickness within normal limits in the left eye. Advanced diagnostic methods along with clinical data enable the distinction from unilateral ectasia cases and subclinical (fruste) keratoconus. Literature review is also performed along with case presentation and discussion. How to cite this article Ramos IC, Reinstein DZ, Archer TJ, Gobbe M, Salomão MQ, Lopes B, Luz A, Faria-Correia F, Gatinel D, Belin MW, Ambrósio R Jr. Unilateral Ectasia characterized by Advanced Diagnostic Tests. Int J Kerat Ect Cor Dis 2016;5(1):40-51.

Intracorneal circular ring implant with femtosecond laser: Pocket versus tunnel

2021 ◽  
pp. 112067212199472
Author(s):  
Luis Izquierdo ◽  
Ana M Rodríguez ◽  
Ramón A Sarquis ◽  
Diego Altamirano ◽  
Maria A Henriquez
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Randomized Study ◽  
Circular Ring ◽  
Continuous Ring ◽  
Refractive Outcomes ◽  
Scheimpflug Imaging ◽  
Ring Segment ◽  
Intracorneal Ring Segment ◽  
Student’S T

Purpose: To evaluate and compare visual and refractive outcomes after implantation of the intracorneal continuous ring 360° arc (ICCR) versus the intracorneal ring segment 340° arc (ICRS) using femtosecond laser for central keratoconus. Setting: Research Department, Oftalmosalud, Instituto de Ojos, Lima, Peru. Methods: Randomized study that included 40 eyes of 32 patients diagnosed with central keratoconus between November 2014 and March 2015. Twenty eyes had an implantation of ICCR (MyoRing, Dioptex GmbH, Austria) through an intrastromal pocket and 20 eyes had an implantation of ICRS (Keraring, Mediphacos, Brazil) through an intrastromal tunnel. Both procedures were performed with a femtosecond laser (LDV Z6 model, Ziemer Ophthalmic Systems AG). Visual acuity (VA), refraction, and Scheimpflug imaging analysis were performed pre- and postoperatively at 1 month and 1 year. Comparisons of means were performed using the Student’s t-test. Results: At 1 year, uncorrected VA improved 0.77 LogMAR ( p < 0.001) in the ICCR group and 0.79 LogMAR ( p = 0.01) in the ICRS group; mean sphere improvement was 5.13 Diopters (D) in the ICCR group and 6.27 D in the ICRS group ( p < 0.001 both); mean Steeper Keratometry improvement was 4.24 D in the ICCR group and 5.53 D in the ICRS group ( p < 0.001 both). In the ICCR group, mean decrease in the pachymetry at the thinnest point of the cornea was 32.16 µm ( p = 0.01), and in the ICRS group, mean increase was 4.2 µm at 1 year ( p = 0.61). Conclusion: Intracorneal continuous ring 360° arc (ICCR) and intracorneal ring segment 340° (ICRS) are effective treatments for central keratoconus. No significant differences between rings were found on visual acuity, refraction, and keratometry improvement.

scholarly journals Effect of monocular surgery for large-angle horizontal deviation in adults

1970 ◽  
Vol 3 (1) ◽  
pp. 27-30 ◽  
Author(s):  
S Ganguly ◽  
R Pradhan
Keyword(s):  
Visual Acuity ◽  
Large Angle ◽  
Anterior Segment ◽  
Case Series ◽  
Strabismus Surgery ◽  
Slit Lamp ◽  
Surgical Success ◽  
Squint Surgery ◽  
Indirect Ophthalmoscope

Background: Surgical success rate of strabismus is variable. Objective: To evaluate the outcome of monocular strabismus surgery for adults with largeangle deviation. Subjects and methods: This study was that of a retrospective interventional case series. A total of 48 consecutive adult patients with large-angle socially-noticeable strabismus underwent clinical evaluation for squint surgery. They were divided into 2 groups of which 28 had exotropia while 20 had esotropia with deviation ranging from 40 to 80 prism diopters (PD). Visual acuity measurement (V/A), cycloplegic refraction and orthoptic evaluation were done in all cases along with detailed anterior segment evaluation. Fundus examination was carried out with indirect ophthalmoscope and slit-lamp bio-microscopy with + 90 D lens. For each case, a repeat evaluation was done after a six-week interval. The surgical procedure was monocular recession and resection carried out under peri-bulbar anesthesia by the same surgeon. Post-operative visual acuity, fusion, stereopsis and ocular alignment were noted in all cases during follow up visits. Results: Successful ocular alignment (< 10 PD) was achieved in 40 patients while binocularity was noted in 3. Forty patients were happy with the cosmetic outcome and psychosocial rehabilitation. No statistically significant improvement was noted in visual acuity and binocular function. Successful alignment was related to pre-operative deviation of less than 30 degrees. Conclusion: Monocular surgery under peri-bulbar anesthesia is a useful procedure for large-angle horizontal strabismus. Key words: strabismus; exotropia; esotropia; fusion; binocularity DOI: 10.3126/nepjoph.v3i1.4275Nepal J Ophthalmol 2011;3(5):27-30

scholarly journals Characterization of the effect of intracorneal ring segment in corneal ectasia after laser refractive surgery

2018 ◽  
Vol 30 (1) ◽  
pp. 125-131
Author(s):  
Cristina Peris-Martínez ◽  
Inmaculada Bueno-Gimeno ◽  
Izaskun Alvarez-Arana ◽  
David P Piñero ◽  
Andrés Gené-Sampedro
Keyword(s):  
Visual Acuity ◽  
Vector Analysis ◽  
Distance Visual Acuity ◽  
Corneal Ectasia ◽  
Uncorrected Distance Visual Acuity ◽  
Corrected Distance Visual Acuity ◽  
Ring Segment ◽  
Intracorneal Ring Segment ◽  
Power Measurements

Purpose: To evaluate the visual, refractive, topographic, pachymetric, and biomechanical outcomes after intracorneal ring segment implantation in corneas with post-LASIK ectasia. Methods: Retrospective longitudinal study enrolling 26 eyes of 22 patients with post-LASIK ectasia and undergoing intracorneal ring segment implantation (KeraRing®, Mediphacos) using a 60-kHz femtosecond laser (IntraLase®, IntraLase Corp.) for corneal tunnelization. Visual, refractive, anterior, and posterior corneal topographic (Pentacam HR, Oculus), pachymetric, and corneal biomechanical changes (Ocular response Analyzer, Reichert) were evaluated during a 12-month follow-up. Vector analysis of astigmatic changes was performed. Results: A statistically significant reduction of sphere (p = 0.043) was observed at 1 month after surgery, with a significant improvement of uncorrected distance visual acuity associated (p = 0.019). Likewise, a significant reduction of anterior corneal power measurements (p ⩽ 0.014) and steepest posterior keratometric reading (p = 0.006) were observed at 1 month postoperatively, with no significant changes afterwards (p ⩾ 0.133). No significant changes were observed in manifest cylinder (p ⩾ 0.175), corrected distance visual acuity (p ⩾ 0.174), flattest posterior keratometric measurement (p ⩾ 0.282), volumetric measurements (p ⩾ 0.051), and corneal biomechanical parameters (p ⩾ 0.068). Vector analysis revealed an initial trend to overcorrection of astigmatism, with a trend to undercorrection at the end of follow-up and a significant variability in the outcome achieved in each patient. Conclusion: The implantation of KeraRing segments in post-LASIK corneal ectasia generates a significant modification of spherical refraction and a visual improvement due to a central corneal flattening generated. More refined nomograms of implantation in these cases should be developed to achieve a more predictable correction of astigmatism.

Assessment of Epithelial Thickness in Keratoconic Patients Before and After Intracorneal Ring Segment Implantation Using Anterior Segment Optical Coherence Tomography

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
R F Mohamed ◽  
R M F Elghazawy ◽  
S M Fawzy ◽  
T A Badran
Keyword(s):  
Visual Acuity ◽  
Anterior Segment ◽  
Case Series ◽  
Treatment Modalities ◽  
Ophthalmological Examination ◽  
Epithelial Thickness ◽  
Case Series Study ◽  
Before And After ◽  
Ring Segment ◽  
Intracorneal Ring Segment

Abstract Background Keratoconus, the most common primary corneal ectasia, is a bilateral asymmetric corneal degeneration accompanied with local corneal thinning and occurs mostly in the inferior and central part of the cornea, it usually causes high myopia and irregular astigmatism which results in poor quality of vision. Based on disease severity, many treatment modalities exist including glasses and contact lenses for mild to moderate disease, while corneal graft preserved for more advanced disease. In advent of alternative treatments, intrastromal ring implantation have been introduced which improves visual acuity and optical aberrations and also corrects refractive errors and mean keratometric data, anterior segment Optical cohehernce Tomography epithelial mapping is anew modality to assess epithelial thickness. Objective: To investigate epithelial thickness changes in keratoconic patients before and after intracorneal ring segment implantation using AS OCT. Methods: Thirty eyes with early to moderate keratoconus were included in this prospective interventional case series study which has been conducted at patients from Ain shams university hospitals, after the approval of the research ethical committee in the Faculty of Medicine, Ain Shams University between March to October. All cases underwent a Complete ophthalmological examination before surgery. the examination included Visual acuity assessment and Best corrected visual acuity. Slit Lamp Biomicroscopy examination with fundus examination through dilated pupil using D lens & Corneal Topography, Anterior segment Optical cohehernce Tomography Epithelial mapping(zeiss). Results: we found that epithelial thickness showing statistically significant change comparing pre and post operative epithelial mapping especially in certain areas in the map,area ( _ ),( _ )  mm. Conclusion: There is increase in epithelium thickness in keratoconic corneas after intracorneal ring segment implantation to compensate for stromal irregularities in patients with keratoconus.

scholarly journals Clinical outcomes after intracorneal ring segment implantation for keratoconus management in corneas with mild apical haze

2021 ◽  
Vol 13 ◽  
pp. 251584142110033
Author(s):  
Mohamed Elalfy ◽  
Sundas Maqsood ◽  
Aja Reinhold ◽  
Georgios D. Panos ◽  
Aye Khine ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Therapeutic Option ◽  
Exclusion Criterion ◽  
Queen Victoria ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Ring Segment ◽  
Corneal Opacities ◽  
Intracorneal Ring Segment

Purpose: The implantation of intracorneal ring segments represents an effective and safe therapeutic option for visual improvement in patients with keratoconus. The presence of corneal opacities is considered an exclusion criterion for this operation. Methods: This is a retrospective cohort study of six eyes of six keratoconus patients at Queen Victoria Hospital, East Grinstead, UK, between January 2012 and December 2016. Femtosecond laser-assisted intracorneal ring segment implantation was performed in six eyes with apical corneal haze. Preoperative and postoperative visual acuity, keratometry readings, as well as corneal pachymetry were compared at 6-month follow-up. Results: Uncorrected visual acuity (UCVA) [LogMAR] improved significantly from median 1.05 [95% confidence interval (CI): 0.83–0.13] preoperatively to 0.9 (95% CI: 0.63–1.00) at 6 months postoperatively ( p = 0.03). Corrected visual acuity (CDVA) also improved significantly from median 0.75 (95% CI: 0.43–1.00) preoperatively to 0.4 (95% CI: 0.23–0.50) at 6 months postoperatively ( p = 0.03). Keratometric readings, K-max (diopters) and K-mean (diopters), decreased significantly from 54.5 and 47.85 preoperatively to 53.45 and 46.42 postoperatively, respectively ( p = 0.03). Corneal pachymetry showed no significant changes postoperatively. Conclusion: The results of this study show that the presence of apical haze should not exclude the implantation of intracorneal ring segments in patients with keratoconus.

scholarly journals Capsular Blockage Syndrome: Clinical and Anterior Segment Optical Coherence Tomography (OCT) Characteristics

2021 ◽  
Author(s):  
Hsin-Yu Yang ◽  
Sui-Ching Kao ◽  
Chieh-Chih Tsai ◽  
Wei-Kuang Yu
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Low Dose ◽  
Anterior Segment ◽  
Topical Steroid ◽  
Anterior Segment Oct ◽  
Corrected Visual Acuity ◽  
Nd:Yag Laser Capsulotomy ◽  
Significant Difference

Abstract Background:CBS is a rare phenomenon which is found during and after cataract surgery. The mechanism, OCT presentation and clinical characteristics are not well studied. Methods:Document patients with CBS who underwent examination, including refraction, best-corrected visual acuity, slit lamp, anterior segment OCT, and onset after cataract surgery. All patients underwent Nd:YAG laser capsulotomy and were prescribed a low-dose topical steroid for seven days. Post-capsulotomy refraction and visual acuity were recorded.Results:This study included 18 eyes. Patients’ mean age was 80 (range, 54–92). The duration between cataract surgery and CBS diagnosis ranged 15–136 months. According to anterior segment OCT findings, we subcategorized the patients into four types: minimally opaque (n=4, 22%), uniformly turbid (n=7, 39%), focally condensed (n=5, 28%), and diffused sparkling (n=2, 11%). After laser capsulotomy, mean visual acuity improved 0.18 ± 0.09 on the LogMar. A significant difference in absolute refraction changes between the groups was noted— maximum in the focally condensed and minimum in the uniformly turbid types. No patient developed complications or needed further treatment for CBS during mean follow-up of 80 months.Conclusion:High-resolution anterior segment OCT is useful for analyzing pathological changes in the CBS. Our study implies that these four types of CBS presentation indicate various causes of late-CBS formation, as well as distinct clinical presentation and post–laser capsulotomy outcome. In addition, YAG laser capsulotomy is a safe late-CBS treatment modality.

Effect of intracorneal ring segment implantation on high order aberrations comparing patients with eccentric versus central keratoconus

2021 ◽  
pp. 112067212110410
Author(s):  
Philipp Anders ◽  
Lisa-Marie Anders ◽  
Mohamed Elalfy ◽  
Samer Hamada ◽  
Berthold Seitz ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Significant Positive Correlation ◽  
Spherical Aberration ◽  
High Order ◽  
Visual Performance ◽  
Mean Square ◽  
Ring Segment ◽  
Intracorneal Ring Segment ◽  
High Order Aberrations

Purpose: To assess potential differences between central and eccentric cones in the aberrometric corneal profile and in visual and keratometric outcomes 6 months after intracorneal ring segment (ICRS) implantation for keratoconus. Methods: This study compared two groups consisting of 12 patients each, with central or eccentric keratoconus who were treated with femtosecond laser-assisted Keraring implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, keratometric readings and higher order aberrations (HOAs) including high order aberrations root mean square (HOARMS), coma, spherical aberration and trefoil were measured preoperatively and 6 months after ICRS implantation. Results: Trefoil and spherical aberration were significantly reduced after ICRS implantation compared to preoperative values in eccentric keratoconus (Trefoil, p = 0.0049; Spherical aberration, p < 0.0001). In central keratoconus spherical aberration was reduced not significantly after ICRS implantation compared to preoperative values ( p = 0.087). Coma showed a significant reduction in central ( p = 0.0001) and in eccentric keratoconus ( p = 0.0001). The reduction of spherical aberration in central keratoconus was significantly positively correlated to improvement in UDVA (Pearson’s correlation coefficient, r = −0.66; p = 0.02). In eccentric keratoconus there was a significant positive correlation between reduction of trefoil and improvement in UDVA (Spearmans R, r = −0.69; p = 0.01). Conclusion: Patients both with central and eccentric keratoconus benefit from ICRS implantation. Specifically, our data provide a slightly higher gain in visual performance for eccentric cones 6 month after ICRS implantation, which is accentuated by a greater reduction in spherical aberration and trefoil. Improvements in UDVA are positively correlated with reductions in HOAs.

scholarly journals Preliminary Results of Femtosecond Laser Assisted Corneal Ring Segment Implantation for Keratoconus

2013 ◽  
Vol 2 (2) ◽  
pp. 47-50
Author(s):  
Vardhaman P Kankariya ◽  
Kemal Ozulken ◽  
Florence Cabot ◽  
Sonia H Yoo
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Safe Procedure ◽  
K Value ◽  
Preliminary Results ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Ring Segment ◽  
Preliminary Study

ABSTRACT Purpose To present refractive, visual and topographic outcomes of femtosecond laser assisted intrastromal ring segments (ISRS) implantation. Settings Bascom Palmer Eye Institute, Miami, FL, USA. Materials and methods Nineteen eyes of 15 patients with keratoconus, clear central corneas, and contact lens intolerance had implantation of a symmetrical 0.45 mm Inta cs segment (Addition Technology Inc, California, USA) using 200 kHz femtosecond laser (WaveLight GmbH, Erlangen, Germany). The outcomes of the procedure were evaluated in terms of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), average keratometry value (K-value) and spheric equivalent (SE). Results Femtosecond laser assisted ISRS implantation could be performed with ease, while no intra- or postoperative complications were encountered. Mean UCVA improved from 0.95 ± 0.39 to 0.66 ± 0.28 logMAR, mean BSCVA improved from 0.46 ± 0.13 to 0.29 ± 0.21 logMAR, mean spherical equivalent considerably reduced from −7.15 ± 4.57 to −4.38 ± 4.07 and K value reduced from 52.39 ± 5.79 to 49.78 ± 6.84 D at the last follow-up. Conclusion Using a 200 kHz femtosecond laser is a safe procedure providing optimal refractive, visual and topographic outcomes in our preliminary study. How to cite this article Ozulken K, Cabot F, Kankariya VP, Yoo SH. Preliminary Results of Femtosecond Laser Assisted Corneal Ring Segment Implantation for Keratoconus. Int J Kerat Ect Cor Dis 2013;2(2):47-50.

scholarly journals Redo surgery using IntraLase femtosecond laser for treating a decentered laser in situ keratomileusis flap

2017 ◽  
Vol 46 (2) ◽  
pp. 901-907
Author(s):  
Yulin Lei ◽  
Jie Hou ◽  
Xiuyun Zheng
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Intraoperative Complications ◽  
Anterior Segment ◽  
Laser In Situ Keratomileusis ◽  
Redo Surgery ◽  
Laser Technique ◽  
Uncorrected Visual Acuity

Objective Decentered flaps are rarely reported after femtosecond laser-assisted in situ keratomileusis flap procedures. We present a patient with a decentered flap after preparation of a corneal flap using the Femto LDV technique. Methods The 22-year-old man required a redo operation because of a decentered corneal flap. It was performed the same day at the patient's insistence and with his consent. The new corneal flap for the redo surgery was prepared using the femtosecond laser technique and IntraLase. Results Uncorrected visual acuity for each eye was 1.2 during the 12-month follow-up. The results of the Femtosecond laser technique showed good predictability and repeatability regarding the preparation of corneal flaps, but it still may cause some intraoperative complications. Conclusion Once redo surgery is needed, the size and depth of the initially prepared flap should be determined using anterior segment optical coherence tomography to pre-set the parameters for preparation of the redo flap.

Sign in / Sign up

Export Citation Format

Share Document