1
|
Sánchez-González MC, Gutiérrez-Sánchez E, Sánchez-González JM, De-Hita-Cantalejo C, Pinero-Rodríguez AM, González-Cruces T, Capote-Puente R. Complications of Small Aperture Intracorneal Inlays: A Literature Review. Life (Basel) 2023; 13:life13020312. [PMID: 36836669 PMCID: PMC9965951 DOI: 10.3390/life13020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023] Open
Abstract
Presbyopia can be defined as the refractive state of the eye in which, due to a physiological decrease in the ability to accommodate, it is not possible to sustain vision without fatigue in a prolonged manner, along with difficulty focusing near vision. It is estimated that its prevalence in 2030 will be approximately 2.1 billion people. Corneal inlays are an alternative in the correction of presbyopia. They are implanted beneath a laser-assisted in situ keratomileusis (LASIK) flap or in a pocket in the center of the cornea of the non-dominant eye. The purpose of this review is to provide information about intraoperative and postoperative KAMRA inlay complications in the available scientific literature. A search was conducted on PubMed, Web of Science, and Scopus with the following search strategy: ("KAMRA inlay" OR "KAMRA" OR "corneal inlay pinhole" OR "pinhole effect intracorneal" OR "SAICI" OR "small aperture intracorneal inlay") AND ("complication" OR "explantation" OR "explanted" OR "retired"). The bibliography consulted shows that the insertion of a KAMRA inlay is an effective procedure that improves near vision with a slight decrease in distance vision. However, postoperative complications such as corneal fibrosis, epithelial iron deposits, and stromal haze are described.
Collapse
Affiliation(s)
| | | | | | | | | | - Timoteo González-Cruces
- Department of Anterior Segment, Cornea and Refractive Surgery, Hospital La Arruzafa, 14012 Cordoba, Spain
| | - Raúl Capote-Puente
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain
| |
Collapse
|
2
|
Pluma-Jaramago I, Rocha-de-Lossada C, Rachwani-Anil R, Sánchez-González JM. Small-aperture intracorneal inlay implantation in emmetropic presbyopic patients: a systematic review. Eye (Lond) 2022; 36:1747-1753. [PMID: 35347289 PMCID: PMC9391325 DOI: 10.1038/s41433-022-02032-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/22/2022] [Accepted: 03/14/2022] [Indexed: 11/09/2022] Open
Abstract
Small-aperture corneal inlays, commonly known as KAMRA, are tiny optical devices inserted in the corneal stroma aiming to gain near vision in patients with presbyopia. The purpose of this study was to systematically review case series of small-aperture corneal inlays performed in presbyopic emmetropic patients and to evaluate the visual outcomes of this procedure. This systematic review included 18 articles published between 2011 and 2018, overall studying 2724 eyes from 2691 participants. The mean longest follow-up was 19 months. Results showed that 78.5% of eyes reported an uncorrected near visual acuity of 20/32 or better and 90.50% of eyes achieved an uncorrected distance visual acuity of 20/25 or better. All patients experienced an improvement in uncorrected near visual acuity with a patient satisfaction ranging between 60% and 90%. The highlighted complications were keratocyte activation leading to corneal stromal haze, epithelial growth, iron deposits and poor distance visual acuity. Explantation was carried out in 101 eyes (3.7%) due to distance vision blurriness, development of epithelial microcysts, incorrect implant placement or hyperopic shift changes. KAMRA demonstrated high efficacy. However, safety and satisfaction rates remain unclear. Despite the low explantation rates reported in the literature, some complications were permanent. The results and conclusions should be taken with caution due to the conflict of interest stated in the reviewed articles.
Collapse
Affiliation(s)
- Inés Pluma-Jaramago
- Department of Physics of Condensed Matter., Optics Area, University of Seville, Seville, Spain
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Department of Ophthalmology, Ceuta Medical Center, Ceuta, Spain
- Department of Ophthalmology (Qvision), Vithas Almería, Almería, Spain
| | | | | |
Collapse
|
3
|
McDonald MB, Mychajlyszyn A, Mychajlyszyn D, Klyce SD. Advances in Corneal Surgical and Pharmacological Approaches to the Treatment of Presbyopia. J Refract Surg 2021; 37:S20-S27. [PMID: 34170764 DOI: 10.3928/1081597x-20210408-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this article is to review the current status of presbyopia amelioration with surgical and pharmacologic procedures that partially compensate for loss of accommodation in advance of cataract surgery and lens replacement. Over the last few years, several corneal surgical and topical pharmacological approaches for the treatment of presbyopia have been introduced to the marketplace or are in the developmental pipeline. The approaches vary in invasiveness, duration of effect, reversibility, risk/benefit ratio, and clinical results. The advantages and disadvantages for each are discussed. Corneal surgical interventions aim to provide improved near and intermediate vision in patients with presbyopia through refractive means that extend ocular depth of focus through shape modification. The use of miotic drops or corneal lamellar implants extend depth of focus with the "pinhole" aperture size reduction effect. Unlike in adults younger than 40 years, the refractive status of the patient with presbyopia is not stable. Hence, procedures that provide a permanent refractive change may not provide long-term full correction; eye drops or other treatments that are self-reversing in time or are easily reversible may be used as needed. On the horizon, procedures are being explored that may add years of functional lens accommodation by preserving the deformable gel properties of the lens. [J Refract Surg. 2021;37(6 Suppl):S20-S27.].
Collapse
|
4
|
Paley GL, Harocopos GJ. Histopathologic Analysis of Explanted KAMRA Corneal Inlays Demonstrating Adherent Fibroconnective Tissue Scar Formation. Ocul Oncol Pathol 2019; 5:440-444. [PMID: 31768368 DOI: 10.1159/000498944] [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: 11/08/2018] [Revised: 02/11/2019] [Indexed: 12/27/2022] Open
Abstract
Objective To investigate the histologic composition of opaque membranes associated with corneal intrastromal inlays implanted for the surgical treatment of presbyopia. Methods This is an observational case series of KAMRA corneal inlays explanted due to the presence of adherent opaque membranes associated with peri-inlay corneal stromal haze and sent for histopathologic analysis. Routine histology was performed in addition to immunohistochemical staining with myofibroblast and keratocyte markers. Results Eleven explanted inlay specimens were received, of which, after histologic processing, four demonstrated suf-ficient cellular material for histopathologic analysis. The opaque membranes surrounding the explanted inlays were composed of fibroconnective tissue, and myofibroblasts (positive for smooth muscle actin immunostain) were the predominant cell type. Immunostaining for the keratocyte marker CD34 was negative, confirming that the membranes were the result of a reactive scar-tissue formation process and not simply normal corneal stroma adherent to the explant. Conclusions Corneal inlay implantation can lead to the formation of an adherent fibroconnective tissue membrane, suggesting keratocyte-to-myofibroblast transdifferentiation and reactive fibroconnective tissue scar formation that could potentially impact visual potential. Prospective patients should be counseled regarding the risk of this complication, as this may be associated with some risk of incomplete reversibility of the procedure.
Collapse
Affiliation(s)
- Grace L Paley
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - George J Harocopos
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
5
|
Romito N, Basli E, Goemaere I, Borderie V, Laroche L, Bouheraoua N. Persistent corneal fibrosis after explantation of a small-aperture corneal inlay. J Cataract Refract Surg 2018; 45:367-371. [PMID: 30584010 DOI: 10.1016/j.jcrs.2018.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/30/2018] [Accepted: 11/04/2018] [Indexed: 11/26/2022]
Abstract
The KAMRA small-aperture corneal inlay can compensate for presbyopia. A small number of complications have been reported, including glare, halos, decentration, iron deposition, compromised distance and night vision, infectious keratitis and reversal corneal haze. We describe a case of corneal fibrosis after small-aperture corneal inlay implantation and its persistence after late explantation. The postoperative period was uneventful, with good uncorrected near and distance visual acuities. Six years after implantation, the patient reported vision loss in the left eye. A slitlamp evaluation and optical coherence tomography showed stromal opacity and a stromal hyperreflective signal at the level of the small-aperture corneal inlay. The corneal inlay was removed, but persistent decreased visual acuity and fibrosis were observed even 8 months after explantation and did not respond to steroids. Long-term monitoring with multimodal imaging methods is important to detect late adverse events after small-aperture corneal inlay implantation.
Collapse
Affiliation(s)
- Norman Romito
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Université, Paris, France
| | - Elena Basli
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Université, Paris, France
| | - Isabelle Goemaere
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Université, Paris, France
| | - Vincent Borderie
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Université, Paris, France; Institut de la Vision, UPMC-Sorbonne Université, INSERM, CNRS UMR 7210, Paris, France
| | - Laurent Laroche
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Université, Paris, France; Institut de la Vision, UPMC-Sorbonne Université, INSERM, CNRS UMR 7210, Paris, France
| | - Nacim Bouheraoua
- Quinze-Vingts National Ophthalmology Hospital, UPMC-Sorbonne Université, Paris, France; Institut de la Vision, UPMC-Sorbonne Université, INSERM, CNRS UMR 7210, Paris, France.
| |
Collapse
|
6
|
Moshirfar M, Desautels JD, Walker BD, Birdsong OC, Skanchy DF, Quist TS, Murri MS, Linn SH, Hoopes PC, Hoopes PC. Long-term changes in keratometry and refraction after small aperture corneal inlay implantation. Clin Ophthalmol 2018; 12:1931-1938. [PMID: 30323549 PMCID: PMC6177373 DOI: 10.2147/opth.s164964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess longitudinal refractive, keratometric, and topographic changes following KAMRA small-aperture inlay implantation. Design and setting Prospective study at a single site refractive surgery center. Methods Fifty patients underwent KAMRA small-aperture corneal inlay implantation for the correction of presbyopia. Uncorrected near visual acuity (UNVA), uncorrected distance visual acuity, manifest refractive spherical equivalent (MRSE), mean keratometry (Km), corneal topography, and surgically induced astigmatism vector analysis assessments were performed preoperatively and at 1, 3, 6, 12, 24, and 36 months postoperatively. Results The study comprises 50 eyes. An average shift of 0.15±0.63 D (range -1.63 to 2.00 D) occurred between preoperative baseline and 36 months. At 36 months, 54% of patients had hyperopic MRSE and 40% had myopic MRSE compared with baseline. Km was significantly elevated at all postoperative measurements compared with baseline, with the largest Km measured at 12 months. Eighty-six percent of patients had UNVA of 20/32 or better and 88% uncorrected distance visual acuity of 20/25 or better at 36 months. Longitudinal corneal topography revealed a pattern of corneal steepening over the body of the inlay and flattening over the aperture, correlating with a hyperopic shift. There was no significant surgically induced astigmatism. Conclusion KAMRA inlay may cause an increase in Km compared with baseline. Corneal steepening may occur in a specific pattern with steepening over the inlay and flattening over the aperture. This topographic pattern causes a hyperopic shift, which may be relevant for subsequent procedures, such as cataract extraction.
Collapse
Affiliation(s)
- Majid Moshirfar
- Hoopes, Durrie, Rivera Research Center, Hoopes Vision, Draper, UT, USA, .,John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA,
| | - Jordan D Desautels
- Hoopes, Durrie, Rivera Research Center, Hoopes Vision, Draper, UT, USA, .,The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Brian D Walker
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Orry C Birdsong
- Hoopes, Durrie, Rivera Research Center, Hoopes Vision, Draper, UT, USA,
| | - David F Skanchy
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tyler S Quist
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Steve H Linn
- Hoopes, Durrie, Rivera Research Center, Hoopes Vision, Draper, UT, USA,
| | - Phillip C Hoopes
- Hoopes, Durrie, Rivera Research Center, Hoopes Vision, Draper, UT, USA, .,John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA,
| | - Phillip C Hoopes
- Hoopes, Durrie, Rivera Research Center, Hoopes Vision, Draper, UT, USA, .,John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA,
| |
Collapse
|
7
|
Ong HS, Chan AS, Yau CW, Mehta JS. Corneal Inlays for Presbyopia Explanted Due to Corneal Haze. J Refract Surg 2018; 34:357-360. [DOI: 10.3928/1081597x-20180308-01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/09/2018] [Indexed: 11/20/2022]
|
8
|
Moshirfar M, Walker BD, Linn SH, Birdsong OC, Hoopes PC. Optimal Pocket Depth for Corneal Inlays. J Refract Surg 2018; 34:288. [PMID: 29634846 DOI: 10.3928/1081597x-20180209-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Balgos MJTD, Vargas V, Alió JL. Correction of presbyopia: An integrated update for the practical surgeon. Taiwan J Ophthalmol 2018; 8:121-140. [PMID: 30294526 PMCID: PMC6169332 DOI: 10.4103/tjo.tjo_53_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Presbyopia results from loss or insufficiency of the eye's accommodative ability, and clinically manifests as the inability to focus near objects on the retina. It is one of the most common causes of visual impairment worldwide especially in adults of productive or working age. Various means of compensating for the loss of accommodative ability have been devised from optical tools such as spectacles and contact lenses, to topical medications and to surgical procedures. A comprehensive search on journal articles about topical and surgical correction of presbyopia was undertaken. The various techniques for presbyopia correction, as enumerated in these articles, are discussed in this paper with the addition of our personal experience and perspective on the future of these techniques.
Collapse
Affiliation(s)
| | | | - Jorge L Alió
- VISSUM Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Spain
| |
Collapse
|
10
|
Sammouh FK, Baban TA, Dandan WN, Warrak EL. Effects of femtosecond and excimer lasers on implanted KAMRA corneal inlay in animal models. J Fr Ophtalmol 2017; 40:403-407. [PMID: 28359626 DOI: 10.1016/j.jfo.2016.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/17/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the effect of femtosecond laser and excimer laser on an intracorneal inlay (KAMRA®) implanted in animal models. METHODS Femtosecond laser was used to create corneal intrastromal pockets at 250μm depth in five porcine eyes. Four intact KAMRA inlays, examined by slit-lamp biomicroscopy and light microscopy, were implanted in the pocket of four eyes. A standard LASIK flap was created above each implanted inlay in the four eyes using a femtosecond laser with flap thicknesses of 150μm, 130μm, 110μm and 90μm. In the fifth porcine eye, a LASIK flap was created using femtosecond laser at 110μm depth, and a fifth inlay was then implanted in the 250μm pocket. Excimer laser ablation was performed under the flap targeting a -3.00 refraction. The inlay was then explanted, examined and reimplanted in the same pocket followed by a second similar excimer laser ablation. RESULTS Significant burn, shrinkage and distortion of microholes were noted in all the first four inlays following the femtosecond laser flap creation at all the various flap thicknesses. The damage was noted to be more prominent as the distance between the flap and inlay decreased. No apparent effect was noted on the fifth inlay following repeated excimer laser ablations. CONCLUSION Unlike excimer laser, femtosecond laser appears to be hazardous and damaging to the intracorneal KAMRA inlay when applied above it.
Collapse
Affiliation(s)
- F K Sammouh
- Department of Ophthalmology, Saint-George Hospital, University Medical Center, Beirut, Lebanon
| | - T A Baban
- Department of Ophthalmology, Saint-George Hospital, University Medical Center, Beirut, Lebanon
| | - W N Dandan
- Department of Ophthalmology, Saint-George Hospital, University Medical Center, Beirut, Lebanon
| | - E L Warrak
- Department of Ophthalmology, Saint-George Hospital, University Medical Center, Beirut, Lebanon.
| |
Collapse
|
11
|
Malandrini A, Martone G, Menabuoni L, Catanese AM, Tosi GM, Balestrazzi A, Corsani C, Fantozzi M. Bifocal refractive corneal inlay implantation to improve near vision in emmetropic presbyopic patients. J Cataract Refract Surg 2016; 41:1962-72. [PMID: 26603405 DOI: 10.1016/j.jcrs.2015.01.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 01/03/2015] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the safety and effectiveness of the Flexivue Microlens corneal inlay for the improvement of near vision in emmetropic presbyopic patients. SETTING Ophthalmology Department, Misericordia e Dolce Hospital, Prato, Italy. DESIGN Prospective interventional case series. METHODS Corneal inlay implantation was performed in nondominant eyes using a 150 kHz femtosecond laser (iFS). Refraction, uncorrected (UNVA) and corrected (CNVA) near visual acuities, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, slitlamp evaluation, wavefront aberrometry, photopic and mesopic contrast sensitivity, anterior segment optical coherence tomography, endothelial cell density, and central corneal thickness measurements were assessed preoperatively and at each postoperative visit. RESULTS The study evaluated 81 eyes. In 26 eyes, the mean preoperative UNVA and UDVA were 0.76 logMAR and 0.00 logMAR, respectively, compared with 0.10 logMAR and 0.15 logMAR, respectively, 36 months postoperatively. Sixteen (62%) of 26 treated eyes lost more than 1 line of UDVA, and 5 (19%) lost more than 2 lines of UDVA. Two eyes (8%) lost more than 1 line of CDVA at 36 months. The mean binocular UDVA was 0.00 logMAR preoperatively and 0.02 logMAR at 36 months. The mean spherical aberration increased after surgery. Statistically significant differences in the mean mesopic and photopic contrast sensitivities at higher spatial frequencies were found between treated eyes and nontreated eyes. Explantation was performed in 6 treated eyes because of halos, glare, and a reduced UDVA. CONCLUSION The corneal inlay might be a safe and effective method of improving UNVA in emmetropic presbyopic patients. FINANCIAL DISCLOSURE Dr. Fantozzi is a member of the Presbia medical advisory board. No other author has a financial or proprietary interest in any material or method mentioned.
Collapse
Affiliation(s)
- Alex Malandrini
- From the Ophthalmology Department (Malandrini, Menabuoni, Catanese, Corsani, Fantozzi), Misericordia e Dolce Hospital, Prato, and the Ophthalmology Department (Martone, Tosi, Balestrazzi), University of Siena, Siena, Italy
| | - Gianluca Martone
- From the Ophthalmology Department (Malandrini, Menabuoni, Catanese, Corsani, Fantozzi), Misericordia e Dolce Hospital, Prato, and the Ophthalmology Department (Martone, Tosi, Balestrazzi), University of Siena, Siena, Italy.
| | - Luca Menabuoni
- From the Ophthalmology Department (Malandrini, Menabuoni, Catanese, Corsani, Fantozzi), Misericordia e Dolce Hospital, Prato, and the Ophthalmology Department (Martone, Tosi, Balestrazzi), University of Siena, Siena, Italy
| | - Anna Maria Catanese
- From the Ophthalmology Department (Malandrini, Menabuoni, Catanese, Corsani, Fantozzi), Misericordia e Dolce Hospital, Prato, and the Ophthalmology Department (Martone, Tosi, Balestrazzi), University of Siena, Siena, Italy
| | - Gian Marco Tosi
- From the Ophthalmology Department (Malandrini, Menabuoni, Catanese, Corsani, Fantozzi), Misericordia e Dolce Hospital, Prato, and the Ophthalmology Department (Martone, Tosi, Balestrazzi), University of Siena, Siena, Italy
| | - Angelo Balestrazzi
- From the Ophthalmology Department (Malandrini, Menabuoni, Catanese, Corsani, Fantozzi), Misericordia e Dolce Hospital, Prato, and the Ophthalmology Department (Martone, Tosi, Balestrazzi), University of Siena, Siena, Italy
| | - Chiara Corsani
- From the Ophthalmology Department (Malandrini, Menabuoni, Catanese, Corsani, Fantozzi), Misericordia e Dolce Hospital, Prato, and the Ophthalmology Department (Martone, Tosi, Balestrazzi), University of Siena, Siena, Italy
| | - Marco Fantozzi
- From the Ophthalmology Department (Malandrini, Menabuoni, Catanese, Corsani, Fantozzi), Misericordia e Dolce Hospital, Prato, and the Ophthalmology Department (Martone, Tosi, Balestrazzi), University of Siena, Siena, Italy
| |
Collapse
|
12
|
Abstract
The treatment of presbyopia has been the focus of much scientific and clinical research over recent years, not least due to an increasingly aging population but also the desire for spectacle independence. Many lens and nonlens-based approaches have been investigated, and with advances in biomaterials and improved surgical methods, removable corneal inlays have been developed. One such development is the KAMRA™ inlay where a small entrance pupil is exploited to create a pinhole-type effect that increases the depth of focus and enables improvement in near visual acuity. Short- and long-term clinical studies have all reported significant improvement in near and intermediate vision compared to preoperative measures following monocular implantation (nondominant eye), with a large proportion of patients achieving Jaeger (J) 2 to J1 (~0.00 logMAR to ~0.10 logMAR) at the final follow-up. Although distance acuity is reduced slightly in the treated eye, binocular visual acuity and function remain very good (mean 0.10 logMAR or better). The safety of the inlay is well established and easily removable, and although some patients have developed corneal changes, these are clinically insignificant and the incidence appears to reduce markedly with advancements in KAMRA design, implantation technique, and femtosecond laser technology. This review aims to summarize the currently published peer-reviewed studies on the safety and efficacy of the KAMRA inlay and discusses the surgical and clinical outcomes with respect to the patient’s visual function.
Collapse
Affiliation(s)
- Shehzad Anjam Naroo
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Paramdeep Singh Bilkhu
- Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, UK
| |
Collapse
|
13
|
Vilupuru S, Lin L, Pepose JS. Reply. Am J Ophthalmol 2016; 161:217-8. [PMID: 26520671 DOI: 10.1016/j.ajo.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 11/30/2022]
|
14
|
Galvis V, Tello A, Parra MM, Leiva F. Comparison of Contrast Sensitivity and Through Focus in Small-Aperture Inlay, Accommodating Intraocular Lens, or Multifocal Intraocular Lens Subjects. Am J Ophthalmol 2016; 161:217. [PMID: 26604125 DOI: 10.1016/j.ajo.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 09/06/2015] [Accepted: 10/01/2015] [Indexed: 10/22/2022]
|
15
|
Abstract
Presbyopia, the physiological change in near vision that develops with ageing, gradually affects individuals older than 40 years and is a growing cause of visual disability due to ageing demographics of the global population. The routine use of computers and 'smartphones', combined with the affluence of the 'baby boomers' generation has set high standards for near vision correction. Corneal inlays are a relatively new treatment modality that is effective at compensating for presbyopia. The dimensions of these devices vary from 2 to 3.8 mm in diameter and 5 to 32 μm in thickness. They are implanted in the anterior corneal stroma of the non-dominant eye, most commonly, in a femtosecond laser created corneal pocket. They improve near vision by increasing the depth of focus, creating a hyper-prolate region of increased central cornea power or providing a refractive add power. This article reviews the literature on the efficacy and safety of corneal inlays.
Collapse
Affiliation(s)
- Aris Konstantopoulos
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, 11 Third Hospital Avenue,169856, Singapore, Singapore
| | | |
Collapse
|
16
|
Warrak EL, Sammouh FK, Baban TA. Corneal inlay implantation to treat extensive glare and photophobia in a young patient with traumatic mydriasis. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jcro.2014.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|