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Clinical Outcomes of a New Type of Continuous Intrastromal Corneal Ring for Treatment of Keratoconus. Cornea 2021; 41:435-442. [PMID: 34267059 DOI: 10.1097/ico.0000000000002807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the efficacy and safety of implantation of a new continuous corneal ring in keratoconic corneas of an Iranian population. METHODS This study was conducted on 95 contact lens-intolerant keratoconic eyes with clear central corneas. A continuous corneal ring, annular intrastromal corneal inlay (AICI), was inserted using femtosecond laser in all cases. Patients were followed up for 1, 3, and 12 months postsurgery. Visual and subjective refractive outcomes were evaluated in each examination. Besides, keratometry and aberrometric values were recorded before and 12 months after surgery. Finally, vector analysis of refractive astigmatism was performed using the Alpins method. RESULTS The uncorrected and corrected distance visual acuities improved significantly 12 months after surgery from 0.91 ± 0.39 to 0.38 ± 0.22 (P < 0 0.001) and 0.33 ± 0.21 to 0.13 ± 0.11 logMAR (P < 0.001), respectively. Moreover, spherical and cylindrical refractive components reduced from -2.52 ± 2.62 to -0.76 ± 1.78 D (P < 0.001) and -4.14 ± 1.64 to -1.91 ± 1.18 D (P < 0.001), respectively. The mean anterior keratometry had a significant reduction 12 months after AICI insertion (P< 0.001). Primary coma and spherical aberration values showed a significant increase (both, P < 0.05). Our results showed 100% safety (safety index: 1.8) and 45% efficacy (efficacy index: 1). CONCLUSIONS AICI implantation seemed to be a safe and effective procedure for improving visual acuity and refractive outcomes in subjects with keratoconus.
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Tabatabaei SA, Soleimani M, Mirghorbani M, Tafti ZF, Rahimi F. Microbial keratitis following intracorneal ring implantation. Clin Exp Optom 2021; 102:35-42. [DOI: 10.1111/cxo.12810] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 04/12/2018] [Accepted: 06/17/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Seyed Ali Tabatabaei
- Ocular Trauma and Emergency Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,
| | - Mohammad Soleimani
- Ocular Trauma and Emergency Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,
| | - Masoud Mirghorbani
- Ocular Trauma and Emergency Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,
| | | | - Firoozeh Rahimi
- Ocular Trauma and Emergency Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,
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Jabbarvand M, Khodaparast M, Jamali A, Ahmadzadeh H, Bordbar S. Changes in the Optical Corneal Densitometry, Visual Acuity, and Refractive Error after the Annular Intracorneal Inlay Implantation. J Curr Ophthalmol 2021; 33:23-30. [PMID: 34084953 PMCID: PMC8102947 DOI: 10.4103/joco.joco_154_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/04/2020] [Accepted: 09/29/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose: To investigate the changes in the optical corneal densitometry as an objective method in assessing the corneal light back-scattering before and 1 year after the annular intracorneal inlay (AICI) implantation into the keratoconic corneas. Methods: Changes in the optical corneal densitometry, visual acuity, refractive, and tomographical status were assessed before and 1 year after the AICI implantation into the corneas with different stages of keratoconus. Optical corneal densitometry was evaluated using the Pentacam-HR in 0–2, 2–6, 6–10, and 10–12 mm rings in the anterior 120 μ, central layers, posterior 60 μ and also the total value were measured for cornea in the Grey Scale Unit criterion. Results: Totally, 34 patients with keratoconus were studied; the uncorrected and best corrected visual acuity were increased after the surgery (0.98 ± 0.25 to 0.53 ± 0.30 logMAR, P < 0.001 and 0.26 ± 0.18 to 0.19 ± 0.14, P = 0.007 logMAR, respectively); the spherical equivalent was decreased from −4.45 ± 2.25 to − 2.06 ± 2.01 D (P = 0.004). AICI implantation led to an increase in the amount of optical corneal densitometry in 0–2 mm central, 2–6 mm central, 6–10 mm central, total central, 2–6 mm posterior, and 2–6 mm total rings (all, P < 0.05); however, a decrease was observed in 0–2 mm anterior ring (P = 0.049). Results of statistical analysis showed that the total optical corneal densitometry, anterior total, and posterior total back-scattering did not change after the AICI implantation (all, P > 0.05). Conclusions: Our results revealed a significant improvement in the visual function, including refractive error and visual acuity following the AICI implantation. Changes in the optical corneal densitometry were different in distinct regions and layers however, the total amount did not change after the AICI implantation.
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Affiliation(s)
- Mahmoud Jabbarvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khodaparast
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Jamali
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hooman Ahmadzadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soodeh Bordbar
- English Department, Iran University of Medical Sciences, Tehran, Iran
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Naderi M, Karimi F, Jadidi K, Mosavi SA, Ghobadi M, Tireh H, Khorrami-Nejad M. Long-term results of MyoRing implantation in patients with keratoconus. Clin Exp Optom 2021; 104:499-504. [PMID: 33689613 DOI: 10.1080/08164622.2021.1878813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Clinical relevance: This study was conducted to evaluate five-year outcomes of MyoRing implantation in patients with keratoconus. The results showed that MyoRing implantation is a minimally invasive procedure and is safe and effective for improving visual acuity and refraction in most patients with keratoconus.Background: The long-term effects of MyoRing implantation on corneal features were studied.Methods: A total of 48 keratoconic eyes of 43 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, gmbh, Linz, Austria) and who had completed five years of follow‑ups were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and assessed pre-operation, and five years post-operatively. As well, post-operation satisfaction was assessed using a validated questionnaire.Results: Five years post-operatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (p < 0.001). Mean UDVA was 1.20 logMAR before the surgery and 0.42 after the surgery (p < 0.001). Mean CDVA was 0.63 logMAR before the surgery and 0.20 logMAR after the surgery (p < 0.001). SE was improved from -6.53 dioptres (D) before the surgery to -2.23 D after the surgery (p < 0.001). Moreover, the results show that the mean K was reduced by 2.82 D after the surgery (p = 0.001). Overall, 81% of patients were moderately to highly satisfied five years after surgery.Conclusion: MyoRing implantation was found to be a minimally invasive procedure, and is safe and effective for improving visual acuity and refraction in most patients with keratoconus.
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Affiliation(s)
- Mostafa Naderi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | - Farshid Karimi
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Khosrow Jadidi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | | | - Mohadeseh Ghobadi
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Tireh
- Department of Epidemiology and Biostatistics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Izquierdo L, Rodríguez AM, Sarquis RA, Altamirano D, Henriquez MA. Intracorneal circular ring implant with femtosecond laser: Pocket versus tunnel. Eur J Ophthalmol 2021; 32:176-182. [PMID: 33579160 DOI: 10.1177/1120672121994729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Luis Izquierdo
- Research Department, Oftalmosalud Institute of Eyes, Lima, Peru
| | - Ana M Rodríguez
- Research Department, Oftalmosalud Institute of Eyes, Lima, Peru
| | - Ramón A Sarquis
- Research Department, Oftalmosalud Institute of Eyes, Lima, Peru
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Sedaghat MR, Momeni-Moghaddam H, Belin MW, Piñero DP, Akbarzadeh R, Ambrósio R, Hosseini SR. Comparative analysis of two different types of intracorneal implants in keratoconus: A corneal tomographic study. Eur J Ophthalmol 2020; 31:1517-1524. [PMID: 33124461 DOI: 10.1177/1120672120963449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate changes in visual acuity and corneal tomographic outcomes at 6 months after femtosecond-laser assisted implantation of two different types of intracorneal implants in keratoconus. METHODS A total of 39 keratoconus eyes implanted with two segments KeraRing (n = 22 eyes) or MyoRing (n = 17 eyes) were enrolled. Tomographic data (Pentacam system, Oculus) were analyzed and correlated with enhancement in uncorrected (UDVA) and corrected distance visual acuity (CDVA). The tomographic indices were front maximum keratometry (Kmax), corneal asphericity (Q-value) on both surfaces, average pachymetric progression indices (PPI), maximum Ambrosio relational thickness (ARTmax), Belin-Ambrósio enhanced ectasia total deviation index (BAD-D), index of surface variance (ISV), vertical asymmetry (IVA), height asymmetry (IHA) and height decentration (IHD). RESULTS LogMAR UDVA and CDVA improved 2.1 (p = 0.003) and 0.7 (p = 0.074) lines with KeraRing, and 8 and 2.5 lines with MyoRing (p = 0.001). The highest and lowest mean differences in the tomographic indices between both groups were related to ISV and IHD, respectively. Changes in all indices differed significantly between two groups except for changes in front corneal astigmatism, ARTmax, ISV, IVA, IHD and IHA (p > 0.05). Correlation of changes in CDVA with changes in other parameters was statistically significant only for IHD in the KeraRing group, while changes in in UDVA were significantly correlated with changes in spherical equivalent, back Q-value, ISV, IVA, and IHA only in the MyoRing group. CONCLUSION Both implants promote corneal shape regularization and an enhancement in UDVA in keratoconus. A considerable flattening effect and reduction in prolateness in the front corneal surface were observed with MyoRing.
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Affiliation(s)
| | - Hamed Momeni-Moghaddam
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.,Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Michael W Belin
- Department of Ophthalmology & Vision Science, University of Arizona, Tucson, AZ, USA
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
| | - Reyhaneh Akbarzadeh
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Renato Ambrósio
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Seyed Rafi Hosseini
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
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Comparison of Visual, Tomographic, and Biomechanical Outcomes of 360 Degrees Intracorneal Ring Implantation With and Without Corneal Crosslinking for Progressive Keratoconus: A 5-Year Follow-up. Cornea 2020; 40:303-310. [PMID: 33543874 DOI: 10.1097/ico.0000000000002407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/26/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the long-term (5 years) results of 360 degrees intracorneal ring (ICR) implantation with and without corneal crosslinking (CXL) in patients with progressive keratoconus (KCN). METHOD This historical cohort study was performed on 35 eyes with progressive KCN, which was randomly divided into 2 groups. Fourteen patients were implanted only with ICR, and 21 patients with KCN were treated with ICR plus CXL simultaneously. Uncorrected distance visual acuity (UCDVA), corrected distance visual acuity (CDVA), and refractive components were collected from patients' medical records. The biomechanical properties of patients were measured using the Corvis ST (Oculus, Inc, Weltzar, Germany). Corneal topography and aberrometry parameters were also recorded from the Pentacam HR device (Oculus). RESULTS Both UCVA and CDVA increased in both groups after ICR implantation; however, this improvement was more significant in the ICR plus CXL group (P = 0.002 and P = 0.001, respectively). The mean improvement of CDVA in patients with ICR implantation with and without CXL was 0.56 ± 0.67 and 0.33 ± 0.61, respectively. A comparison of the long-term postoperative Tomographic and Biomechanical Index between 2 groups showed a better result in the ICR plus CXL group (P = 0.012). Topographic findings of the anterior corneal surface (flat-K, steep-K, mean-K, and astigmatism) after surgery were significantly better than before surgery in both groups (P < 0.05). CONCLUSIONS Although ICR implantation alone might halt the KCN progression with acceptable visual, topographic, and biomechanical outcomes, the combination of ICR and CXL has an adjuvant and synergistic effect, especially in long-term follow-up.
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Corneal higher-order aberrations after crosslinking and intrastromal corneal ring segments for keratoconus. J Cataract Refract Surg 2020; 46:979-985. [DOI: 10.1097/j.jcrs.0000000000000209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anatomical and Visual Effects of the MyoRing Implantation Measured by the ABCD Keratoconus Grading System. Eye Contact Lens 2020; 46:52-56. [DOI: 10.1097/icl.0000000000000595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Femtosecond Laser Implantation of a 355-Degree Intrastromal Corneal Ring Segment in Keratoconus: A Three-Year Follow-Up. J Ophthalmol 2019; 2019:6783181. [PMID: 31687200 PMCID: PMC6803737 DOI: 10.1155/2019/6783181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the outcomes of femtosecond laser-assisted implantation of a 355-degree intracorneal ring (ICR) (Keraring) in patients with keratoconus in the three-year follow-up. Setting Future Femtolaser Center, Sohag, Egypt. Design Prospective interventional case series. Patients and Methods A prospective case series of 38 eyes of 26 patients with keratoconus had implantation of the 355-degree ICR keraring after tunnel creation with a femtosecond laser. The uncorrected visual acuities (UCVA) and best-corrected visual acuities (BCVA), sphere, cylinder, and manifest refraction spherical equivalent (SE), and mean keratometry (K), K max, and K min were evaluated preoperatively and 3, 6, 12, 24, and 36 months postoperatively, and all complications were reported. Results 38 eyes of 26 patients with mean age 25.92 ± 5.44 years were enrolled in the study, 11 were males (42.3%). The mean UCVA improved from 0.93 ± 0.21 to 0.63 ± 0.21 logMAR (P ≤ 0.001) and the mean BCVA from 0.67 ± 0.22 to 0.43 ± 0.26 logMAR (P < 0.001). The mean sphere, cylinder, and spherical equivalent have been changed dramatically from preoperative to 3 month postoperative, which is statistically significant (P ≤ 0.001), and the changes between 1 and 2 years and 2 and 3 years are also considerable and statistically significant; the K max and K min and K mean improved and the changes were statistically significant (P ≤ 0.001), and the changes between one, two, and three years were also statistically significant. The safety and efficacy indices were changed through the three-year follow-up. The complications were corneal neovascularization (36.84%), corneal melting (26.3%), and ring extrusion (31.5%) at the end of the study. Conclusions Implantation of a 355-degree intracorneal keraring using femtosecond laser improved the visual, refractive, and topographic parameters in keratoconus patients, with a high rate of ICR extrusion and instability. The study has been registered for the Pan African Clinical Trial Registry (http://www.pactr.org) database within No: PACTR201810796878908 on 29 October 2018.
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Khorrami-Nejad M, Aghili O, Hashemian H, Aghazadeh-Amiri M, Karimi F. Changes in Corneal Asphericity after MyoRing Implantation in Moderate and Severe Keratoconus. J Ophthalmic Vis Res 2019; 14:428-435. [PMID: 31875097 PMCID: PMC6825702 DOI: 10.18502/jovr.v14i4.5443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 02/06/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the effect of MyoRing implantation on corneal asphericity in moderate and severe keratoconus (KCN). METHODS This cross-sectional observational study comprised 32 eyes of 28 patients with KCN, who had femtosecond-assisted MyoRing corneal implantation. The primary outcome measures were preoperative and six-month postoperative corneal asphericity in 6-, 7-, 8-, 9-, and 10-mm optical zones in the superior, inferior, nasal, temporal, and central areas. The secondary outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, thinnest location value, and keratometry readings. RESULTS A significant improvement in the UDVA and CDVA was observed six months after the surgery (P < 0.001) with a significant reduction in the spherical (4.67 diopters (D)) and cylindrical (2.19 D) refractive errors. A significant reduction in the corneal asphericity in all the optical zones and in the superior, inferior, nasal, temporal, and central areas was noted (P < 0.001). The mean thickness at the thinnest location of the cornea decreased from 437.15 ± 30.69 to 422.81 ± 36.91 μm. A significant corneal flattening was seen. The K1, K2, and Km changes were 5.32 D, 7 D, and 6.17 D, respectively (P < 0.001). CONCLUSION MyoRing implantation is effective for improving corneal asphericity in patients with KCN. It allows successful corneal remodeling and provides a significant improvement in UDVA, CDVA, and refractive errors.
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Affiliation(s)
- Masoud Khorrami-Nejad
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ozra Aghili
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hesam Hashemian
- Eye Research center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Aghazadeh-Amiri
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshid Karimi
- Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Efficacy of complete rings (MyoRing) in treatment of Keratoconus: a systematic review and meta-analysis. Int Ophthalmol 2019; 39:2929-2946. [DOI: 10.1007/s10792-019-01121-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
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Yousif MO, Said AMA. Contralateral eye study of refractive, topographic and aberrometric outcomes after femtosecond assisted MyoRing implantation and DALK for management of keratoconus. Int J Ophthalmol 2018; 11:1621-1630. [PMID: 30364157 DOI: 10.18240/ijo.2018.10.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/12/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy of femtosecond laser assisted MyoRing intrastromal corneal implant and deep anterior lamellar keratoplasty (DALK) for management of moderate to advanced keratoconus regarding the degree of changes in visual acuity, refraction, corneal asphericity and aberrations. METHODS A prospective non comparative interventional case study was conducted in Ophthalmology Department, Ain Shams University Hospital in the period from January 2015 to February 2017. The study included 30 eyes of moderate to advanced keratoconus. MyoRing was implanted in one eye (Group I) and DALK operation was performed in the contralateral eye of the same patient (Group II). Preoperative and 6mo post-operative uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), corneal and refractive astigmatisms, keratometry and Q-value using topography images were acquired. Quality of vision was assessed in all eyes including total corneal, anterior corneal high order aberrations analysis at 5 mm pupil size and the Strehl ratio of point spread function (PSF) as an objective measure of glare. RESULTS Mean postoperative UCVA, CDVA, SE, refractive astigmatism, keratometry readings and asphericity were statistically improved compared to preoperative parameters in both groups (P<0.05). Significant reduction of all corneal aberrations following both techniques (P<0.05) was achieved except mean trefoil and mean PSF in Group I (P>0.05). Postoperative corneal aberrations were significantly lower in Group II compared to Group I. A statistically significant negative correlation was found in Group I between the mean change in CDVA (logMAR) and the mean preoperative and mean postoperative total corneal aberrations root mean square (RMS; r=-0.78, P=0.04). Also a statistically significant negative correlation was found between mean preoperative coma RMS and mean post PSF (r=-0.86, P=0.01). In Group II, there was a statistically significant positive correlation between mean change in CDVA (logMAR) and mean change in Kmax (r=0.87, P=0.01) and between mean change in refractive cylinder and mean postoperative PSF (r=0.76, P=0.05). CONCLUSION Femtosecond laser assisted MyoRing and DALK are effective in improving visual acuities, refraction, corneal asphericity and aberrations. MyoRing reduced spherical error more than the corneal cylinder. Post operative homogenous corneal surface and good image quality were achieved following both techniques compared to the preoperative state. However, DALK results in better image quality and lower corneal aberrations.
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Affiliation(s)
- Mohamed Omar Yousif
- Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo 11736, Egypt
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Pirhadi S, Mohammadi N, Mosavi SA, Daryabari H, Aghamollaei H, Jadidi K. Comparison of the MyoRing implantation depth by mechanical dissection using PocketMaker microkeratome versus Melles hook via AS-OCT. BMC Ophthalmol 2018; 18:137. [PMID: 29879937 PMCID: PMC5992749 DOI: 10.1186/s12886-018-0806-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background This paper seeks to evaluate the depth and outcomes of MyoRing implantation using two mechanical dissection procedures including: PocketMaker microkeratome in opposition to the Melles hook method. Methods This retrospective study was carried out on 39 eyes of 38 keratoconus patients (28 male and 10 female) with the mean age of \documentclass[12pt]{minimal}
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\begin{document}$$ 28.97\frac{+}{.}10.37 $$\end{document}28.97+.10.37 years and had undergone MyoRing implantation by the two mentioned methods. The MyoRing was inserted into the corneal pocket which was made manually in 18 eyes (Melles hook group) or with PocketMaker microkeratome in 21 eyes (PocketMaker group). The mean follow up time was \documentclass[12pt]{minimal}
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\begin{document}$$ 9.81\frac{+}{.}3.7 $$\end{document}9.81+.3.7 months with pre-operative and post-operative ophthalmic examination including uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), keratometry readings and central corneal thickness measurement. AS-OCT (Casia, SS-1000, Tomey, Nagoya, Japan) imaging was used to measure MyoRing insertion depth, exactly. Results Pre-operative and post-operative UCVA (LogMAR) mean change for the PocketMaker and Melles hook groups were recorded at 0.75 ± 0.32 and 0.78 ± 0.33, respectively. Similarly, BCVA (LogMAR) mean change were 0.27 ± 0.22 and 0.23 ± 0.22. Mean keratometry (Kmean) change were 6.06 ± 4.18 and 6.56 ± 3.55 respectively. UCVA change (P = 0.767), BCVA change (P = 0.77) and Kmean change (P = 0.693) showed that there was no statistically significant difference between both groups for any parameter. Depth measurements achieved from AS-OCT images showed that there was no statistically significant difference in pocket depth between two methods of MyoRing implantation (P = 0.413). Conclusions The results of Myoring implantation outcomes using mechanical dissection via PocketMaker microkeratome as against Melles hook are comparable.
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Affiliation(s)
- Shiva Pirhadi
- Department of Biomedical Engineering, Tehran Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Neda Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hashem Daryabari
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hossein Aghamollaei
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Khosrow Jadidi
- Department of Ophthalmology, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Pashtaev NP, Pozdeeva NA, Zotov VV, Sinitsyn MV, Shcheglova MA. [Strength properties of rabbit cornea after femtosecond laser keratoplasty with and without different intracorneal implants]. Vestn Oftalmol 2018. [PMID: 29543194 DOI: 10.17116/oftalma2018134118-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM to conduct a comparative experimental study of the effect of the use of intracorneal implants during femtosecond laser-assisted intrastromal pocket (IP) and intrastromal tunnel (IT) formation on the strength properties of the cornea. MATERIAL AND METHODS The experimental study was performed on 24 corneas of 12 rabbit eyes enucleated 1 month after slaughtering. All eyes were divided into 6 groups according to the method of operation. IP and IT were created with IntraLase FS 60 kHz femtolaser. Group 1 (control group) consisted of rabbit eyes with intact corneas. In group 2 corneas, intrastromal tunnels were formed, in group 3 - intrastromal pockets, and in group 4 - intrastromal tunnels with 2 intracorneal segments (ICS). In groups 5 and 6, intrastromal pockets, each supplemented with an intrastromal ring, were created at the depth of 62-72% and 80% of pachymetry readings from the 5.0-mm optical zone, respectively. RESULTS Higher voltage had to be applied to stretch the samples from group 2 as compared to those from groups 3 and 6. Distribution of the Young's modulus of the test corneas agreed with voltage distribution in the study groups. CONCLUSION IP was associated with greater reduction in corneal biomechanical stability as compared with IT. Ring implantation into an IP yielded a more pronounced increase in the strength properties of the cornea than ICS implantation into an IT. The result was also more favorable at greater depths of intrastromal ring implantation.
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Affiliation(s)
- N P Pashtaev
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley prospekt, Cheboksary, Russian Federation, 428028
| | - N A Pozdeeva
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley prospekt, Cheboksary, Russian Federation, 428028
| | - V V Zotov
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley prospekt, Cheboksary, Russian Federation, 428028
| | - M V Sinitsyn
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley prospekt, Cheboksary, Russian Federation, 428028
| | - M A Shcheglova
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley prospekt, Cheboksary, Russian Federation, 428028
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Sadoughi MM, Einollahi B, Veisi AR, Zare M, Sedaghat MR, Roshandel D, Einollahi N, Rezaei J. Femtosecond laser implantation of a 340-degree intrastromal corneal ring segment in keratoconus: Short-term outcomes. J Cataract Refract Surg 2017; 43:1251-1256. [DOI: 10.1016/j.jcrs.2017.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022]
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Pashtaev NP, Pozdeeva NA, Sinitsyn MV. [Comparative analysis of corneal aberrations after intrastromal segments and MyoRing implantation using femtosecond laser in patients with keratoconus]. Vestn Oftalmol 2017; 133:3-8. [PMID: 28745650 DOI: 10.17116/oftalma201713334-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM to comparatively analyze corneal aberrations after intrastromal corneal segments (ICS) and MyoRing implantation using femtosecond laser in patients with stage II-III keratoconus (KC) by Pentacam examination. MATERIAL AND METHODS We have operated on 135 patients (145 eyes) with stage II or III KC. Depending on surgical technique, all patients were divided into two groups. Group I consisted of patients with KC, who received optimized femtosecond laser-assisted MyoRing implantation, group II - of those, who received femtosecond laser-assisted ICS implantation. Depending on the stage of the disease, each group was further divided into two subgroups, for stage II and stage III KC, respectively. Before and after surgery, all patients underwent visometry, biomicroscopy, corneal topography, and corneal aberrations measurement under photopic and mesopic conditions on Pentacam. The follow-up period averaged 30 months (from 6 to 34 months). RESULTS In both groups corneal aberrations significantly decreased after surgery, which was confirmed by an improvement in parameters of refraction and keratometry readings. CONCLUSION Implantation of intrastromal MyoRings leads to a greater reduction in the total corneal aberration, higher-order aberrations under photopic and mesopic conditions, and spherical aberration under photopic conditions as compared to ICS in patients with stage III KC; a comparable reduction in the total corneal, higher-order, and spherical aberrations under photopic conditions as compared to ICS in patients with stage II KC; a comparable increase in spherical aberration under mesopic conditions as compared to ICS in patients with stage III KC.
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Affiliation(s)
- N P Pashtaev
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley St., Cheboksary, Chuvash Republic, Russia, 428028; I.N. Ulyanov Chuvash State University, 15 Moskovskiy pr., Cheboksary, Russia, 428015
| | - N A Pozdeeva
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley St., Cheboksary, Chuvash Republic, Russia, 428028
| | - M V Sinitsyn
- Cheboksary branch of S. Fyodorov Eye Microsurgery Federal State Institution, 10 Traktorostroiteley St., Cheboksary, Chuvash Republic, Russia, 428028
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Daxer A. MyoRing treatment of myopia. JOURNAL OF OPTOMETRY 2017; 10:194-198. [PMID: 27461520 PMCID: PMC5484779 DOI: 10.1016/j.optom.2016.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/03/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Laser Vision Correction is not always possible for the treatment of myopia. The aim of this paper is to present results after MyoRing implantation in myopic eyes who in their majority were not eligible for LVC. Safety, effectivity and patient selection is discussed. The aim of the treatment was to be spectacle independent in everyday-life. MATERIALS AND METHODS 19 myopic eyes of 12 patients ranging from -2.25 to -16.5 dioptres (D) in sphere and from 0 to -4D in cylinder were analyzed. RESULTS After treatment, 84% of the eyes reached uncorrected distance visual acuity (UDVA) of 0.5 or better, 42% reached UDVA of 0.8 or better and 16% reached UDVA of 1.0 or better. Before treatment, no eye reached UDVA of 0.5 or better. Corrected distance visual acuity (CDVA) preoperatively and postoperatively did not differ. The treatment changed the average spherical equivalent from -10.27D to -0.93D. Efficacy index was 0.76 and safety index was 1.02. CONCLUSION MyoRing implantation for myopia is safe and effective with highly satisfied patents in a particular subgroup of myopic patients. Patient selection is important.
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Affiliation(s)
- Albert Daxer
- GutSehen Eye Center, Ybbs, Austria; Department of Ophthalmolgy, Medical University of Innsbruck, Austria.
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Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities. Eye Contact Lens 2017; 43:141-154. [DOI: 10.1097/icl.0000000000000270] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Daxer A, Ettl A, Hörantner R. Long-term results of MyoRing treatment of keratoconus. JOURNAL OF OPTOMETRY 2017; 10:123-129. [PMID: 26922840 PMCID: PMC5383460 DOI: 10.1016/j.optom.2016.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 12/29/2015] [Accepted: 01/11/2016] [Indexed: 05/21/2023]
Abstract
PURPOSE To study long-term results of MyoRing treatment of keratoconus. METHODS Retrospective study of MyoRing implantation into a corneal pocket for keratoconus. RESULTS Corneal thickness at the thinnest point remained unchanged, SIM K's, manifest sphere and cylinder were significantly improved at the first follow-up 9 months postoperatively and remained stable until the last follow-up about 5 years after surgery. Uncorrected and corrected distance visual acuity (UDVA, CDVA) were significantly improved at the first follow-up 9 months postoperatively and were further ameliorated until the last follow-up about 5 years after surgery. CONCLUSION The treatment was safe and effective with continuing improvement of visual acuity during the 5 years after surgery.
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Affiliation(s)
- Albert Daxer
- Gutsehen Eye Center, Ybbs/Vienna, Austria; Department of Ophthalmology, Medical University, Innsbruck, Austria.
| | - Armin Ettl
- Department of Ophthalmology, Medical University, St. Pölten, Austria
| | - Robert Hörantner
- Department of Ophthalmology, Hospital Barmherzige Schwestern, Ried, Austria
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Confocal biomicroscopic changes of the corneal layers following femtosecond laser-assisted MyoRing implantation in keratoconus. J Curr Ophthalmol 2016; 29:182-188. [PMID: 28913508 PMCID: PMC5587231 DOI: 10.1016/j.joco.2016.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 11/19/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the effect of the femtosecond laser-assisted MyoRing implantation on the confocal biomicroscopic findings in different corneal layers of the patients with keratoconus. Methods Twelve eyes of 12 patients with mild to moderate keratoconus (keratometry between 48 and 52 diopters) and intolerance to hard contact lens entered the study. All the included patients underwent femtosecond laser-assisted MyoRing (Dioptex GmBH, Linz, Austria) implantation. The confocal biomicroscopy of the cornea was performed for all corneal layers in the center and periphery preoperatively and 3 and 6 months postoperatively. The cell counts and the qualitative findings in each layer of the cornea were compared between preoperative and 3 and 6 months postoperative images. Results Compared with preoperative values, the central epithelial and the central and peripheral midstromal cell counts were significantly decreased 6 months after MyoRing implantation (P = 0.015, P = 0.010 and 0.005, respectively). Furthermore, compared with preoperative values, the peripheral posterior stromal cell count was significantly decreased 3 months after MyoRing implantation (P = 0.033). In the qualitative analysis, highly reflective nuclei in the basal epithelium, transient disruption in the subepithelial nerve plexus, increase in the reflectivity of the stromal keratocyte, and normal endothelial cell morphology were seen. Conclusions Our study demonstrated some findings similar to that reported in intrastromal corneal ring segments (ICRS): decreased central epithelial cell counts, highly reflective nuclei in the basal epithelium, transient disruption in the subepithelial nerve plexus, and normal endothelial cell count and morphology. In addition, a decrease in the central and peripheral midstromal, transient decrease in posterior stromal cell counts, and absence of amorphous depositions were in contrast with the findings reported in ICRS.
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Mid-Term Results of a Single Intrastromal Corneal Ring Segment for Mild to Moderate Progressive Keratoconus. Cornea 2016; 36:530-534. [DOI: 10.1097/ico.0000000000001115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Al-Tuwairqi WS, Osuagwu UL, Razzouk H, AlHarbi A, Ogbuehi KC. Clinical evaluation of two types of intracorneal ring segments (ICRS) for keratoconus. Int Ophthalmol 2016; 37:1185-1198. [DOI: 10.1007/s10792-016-0385-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/22/2016] [Indexed: 11/25/2022]
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Janani L, Jadidi K, Mosavi SA, Nejat F, Naderi M, Nourijelyani K. MyoRing Implantation in Keratoconic Patients: 3 years Follow-up Data. J Ophthalmic Vis Res 2016; 11:26-31. [PMID: 27195081 PMCID: PMC4860982 DOI: 10.4103/2008-322x.180713] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate long-term follow-up data on implantation of a full-ring intra-corneal implant (MyoRing) for management of keratoconus. Methods: A total of 40 keratoconic eyes of 37 consecutive patients who had undergone MyoRing implantation using the Pocket Maker microkeratome (Dioptex, GmbH, Linz, Austria) and completed 3 years of follow-up appointments were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction and keratometry (K) readings were measured and evaluated preoperatively, and 3 years, postoperatively. Results: No intraoperative complications were observed in this case series. Three years postoperatively, there was a significant improvement in UDVA, CDVA, K readings, spherical equivalent (SE), and manifest sphere and cylinder (P < 0.05 for all comparisons). UDVA was significantly improved from 1.14 ± 0.27 to 0.30 ± 0.21 LogMAR (P = 0.001), CDVA was also improved from 0.52 ± 0.23 to 0.18 ± 0.12 LogMAR (P = 0.001), SE was decreased by 4.35 diopters (D) and average keratometric values were reduced by 2.34 D (P = 0.001). Overall, 81% of subjects were moderately to highly satisfied 3 years after surgery and 64.90% agreed to have the fellow eye implanted with MyoRing. Conclusion: MyoRing implantation using the Pocket Maker microkeratome was found to be a minimally invasive procedure for improving visual acuity and refraction in the majority of the patients with keratoconus.
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Affiliation(s)
- Leila Janani
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Khosrow Jadidi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | | | - Farhad Nejat
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | - Mostafa Naderi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, Iran
| | - Keramat Nourijelyani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
To evaluate the biomechanics of corneal ring implants by providing a related mathematical theory and biomechanical model for the treatment of myopia and keratoconus.
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Visual outcomes after femtosecond-assisted intracorneal MyoRing implantation: 18 months of follow-up. Graefes Arch Clin Exp Ophthalmol 2015; 254:917-22. [DOI: 10.1007/s00417-015-3231-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/12/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022] Open
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Mojaled Nobari S, Villena C, Jadidi K. Full-Ring Intracorneal Implantation in Corneas With Pellucid Marginal Degeneration. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e28974. [PMID: 26756018 PMCID: PMC4706990 DOI: 10.5812/ircmj.28974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/29/2015] [Accepted: 10/19/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Keratoconus (KCN) is a progressive, non-inflammatory ectacic disorder characterized by bilateral and asymmetrical conical protrusion of the cornea. MyoRing implantation and Collagen Crosslink (CXL) are two separate effective treatments for all stages of keratoconous. This study wants to show the effect of these treatments combination in patients with moderate and severe keratoconus. OBJECTIVES The aim of this study was to report on the visual and refractive outcomes of corneas with pellucid marginal degeneration following MyoRing implantation (DIOPTEX GmbH). PATIENTS AND METHODS This study included 15 eyes of 15 patients, with an age range from 22 to 49 years old, and pellucid marginal degeneration. An intrastromal corneal ring (MyoRing) was inserted by the means of mechanical dissection using a PocketMaker microkeratome. The main outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and keratometry readings. The mean postoperative follow-up was ten months (range 6 - 12 months). RESULTS The mean UDVA (LogMAR) improved significantly from 1.13 ± 0.21 preoperatively to 0.24 ± 0.13 postoperatively (P < 0.001), and the mean CDVA (LogMAR) improved significantly from 0.39 ± 0.12 to 0.19 ± 0.09 (P < 0.001). The mean cylinder of manifest refraction decreased significantly by 4.00 diopter (D) (P < 0.001). The mean spherical equivalent error (SE) decreased significantly from -6.00 ± 3.60 D to -0.70 ± 1.90 D, at the end of the follow-up period. Furthermore, with regards to corneal topography, a significant reduction was observed in keratometric values. The Kmax, Kmin and Kaverage decreased significantly by 5.00, 1.10 and 4.00 D, respectively (P < 0.001). CONCLUSIONS MyoRing implantation using the PocketMaker microkeratome appears to provide an effective method for treating pellucid marginal degeneration. Both UDVA and CDVA improved significantly. The corneal steepening and astigmatism were reduced in all subjects after MyoRing implantation.
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Affiliation(s)
- Sahar Mojaled Nobari
- Department of Optics II (Optometry and Vision), Complutense University, Madrid, Spain
| | - Consuelo Villena
- Department of Optics II (Optometry and Vision), Complutense University, Madrid, Spain
| | - Khosrow Jadidi
- Department of Ophthalmology, Bina Eye Hospital Research Center, Tehran, IR Iran
- Corresponding Author: Khosrow Jadidi, Bina Eye Hospital Research Center, Tehran, IR Iran. Tel: +98-9121053475, Fax: +98-2122528042, E-mail:
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Reshaping procedures for the surgical management of corneal ectasia. J Cataract Refract Surg 2015; 41:842-72. [PMID: 25840308 DOI: 10.1016/j.jcrs.2015.03.010] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 07/15/2014] [Accepted: 07/23/2014] [Indexed: 12/31/2022]
Abstract
UNLABELLED Corneal ectasia is a progressive, degenerative, and noninflammatory thinning disorder of the cornea. Recently developed corneal reshaping techniques have expanded the treatment armamentarium available to the corneal specialist by offering effective nontransplant options. This review summarizes the current evidence base for corneal collagen crosslinking, topography-guided photorefractive keratectomy, and intrastromal corneal ring segment implantation for the treatment of corneal ectasia by analyzing the data published between the years 2000 and 2014. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Histological and confocal changes in rabbit cornea produced by an intrastromal inlay made of hexafocon A. Cornea 2015; 34:78-81. [PMID: 25357077 DOI: 10.1097/ico.0000000000000289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to evaluate biocompatibility of a newly proposed intrastromal inlay in rabbit corneas. METHODS Eighteen eyes of 9 New Zealand rabbits were included in this prospective study. An intrastromal pocket was created in both eyes using Melles instruments. Annular intracorneal inlays made of hexafocon A were implanted randomly into the stromal pocket of one eye of each rabbit. Confocal microscopy was performed at each visit during 6-month follow-up. After 6 months, the rabbits were killed and corneal tissues of both eyes were sent for light microscopic studies. RESULTS Mild stromal edema was present during the first few days and disappeared afterward with mild haze around the tunnel site in all cases. Deposits around the lamellar channel developed in 3 implanted eyes and in none of the pocket-only eyes. No neovascularization or epithelial downgrowth was present at the incision site in any case. All inlays remained centered and optically clear. In confocal imaging, we observed no significant difference in keratocyte cell density and inflammatory cells between the control pocket-only group and inlay group. In pathological evaluation, there was no difference in the average epithelial thickness between both groups. Descemet membrane and endothelium appeared normal in both groups. CONCLUSIONS This study revealed safety and biocompatibility of hexafocon A as an intracorneal inlay in rabbits.
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Outcome of complete intrastromal ring implantation using femtosecond laser in pellucid marginal degeneration. Eye (Lond) 2015; 29:783-90. [PMID: 25853393 DOI: 10.1038/eye.2015.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 02/01/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the effect of complete intrastromal corneal ring implantations on patients with pellucid marginal degeneration (PMD). DESIGN Prospective interventional case series. PATIENTS AND METHODS Thirty-three eyes with PMD were included into the study. After pocket creation with femtosecond laser (Femtec; 20/10 PerfectVision), MyoRing implantation was performed. Uncorrected and corrected distance visual acuity (UDVA, CDVA), subjective refraction, keratometry, central corneal thickness, corneal biomechanical profile (Ocular Response Analysis), and whole-eye wavefront aberrometry (iTrace) were evaluated preoperatively and also postoperatively, 1 month, 3 months, 6 months, and 1 year after the operation. RESULTS One month after surgery, significant improvements were observed in UDVA (ANOVA; P=0.02), mean keratometry, sphere (ANOVA; P <0.001), and cylinder (ANOVA; P=0.04) with no significant changes afterwards. No significant change occurred in the corneal biomechanical profile. Primary coma and trefoil reduced after 1 year (ANOVA; P values were 0.02 and 0.06, respectively). Primary spherical aberration significantly increased according to the 1-year follow-up (ANOVA; P<0.001). No significant complication was observed. CONCLUSION MyoRing is considered as a treatment modality for spherocylindrical correction in patients with PMD, with an acceptable safety and efficacy profile.
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Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
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Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
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Clinical outcomes after complete intracorneal ring implantation and corneal collagen cross-linking in an intrastromal pocket in one session for keratoconus. J Ophthalmol 2014; 2014:568128. [PMID: 25276417 PMCID: PMC4172981 DOI: 10.1155/2014/568128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 08/23/2014] [Accepted: 08/24/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of this work was to evaluate the results after combined surgery implantation of full rings and CXL in one session in a group of patients with keratoconus during a 12-month follow-up. Material and Methods. The study included 22 eyes of 20 keratoconic patients, mean age of 28.41 (from 18 to 50) years. A full ring was inserted and afterwards 0.1% riboflavin solution was injected into the corneal pocket through the incision tunnel. The cornea was irradiated with UV-A light for 30 minutes. Postoperative visits were scheduled for the first week and months 1, 3, 6, 12, and 24 after surgery. Minimal follow-up time was 12 months. Results. The mean UDVA improved by 6 lines from before the operation to 1 year after the operation, the mean CDVA improved by approximately 2.5 lines, and the mean K improved by 3.94 D. Statistically significant reductions of sphere (P < 0.001), cylinder (P = 0.004), and spherical (P < 0.001) equivalents were found 1 month after surgery. Conclusion. The combined surgery MyoRing implantation and CXL seems to be a safe method in the treatment of keratoconus. We noticed an improvement of the refractive error in all of our patients.
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Jabbarvand M, Hashemian M, Hashemian H, Bazvand F, Khodaparast M. Femtosecond Laser-Assisted MyoRing Implantation in Postoperative LASIK Ectasia. J Refract Surg 2014; 30:462-6. [DOI: 10.3928/1081597x-20140521-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/04/2014] [Indexed: 11/20/2022]
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Implantation of a Complete Intrastromal Corneal Ring at 2 Different Stromal Depths in Keratoconus. Cornea 2014; 33:141-4. [DOI: 10.1097/ico.0000000000000026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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