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

Vision ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 45
Author(s):  
Cameron A. McLintock ◽  
James McKelvie ◽  
Ye Li ◽  
Samer Hamada ◽  
Damian Lake
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Cross Linking ◽  
Visual Rehabilitation ◽  
Queen Victoria ◽  
Intrastromal Corneal Ring ◽  
Uncorrected Visual Acuity ◽  
History Of ◽  
Corneal Collagen ◽  
Corneal Tomography

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

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

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ahmed Ibrahim Basiony ◽  
Moataz Fayez ElSawy ◽  
Mahmoud Mohamed Ismail ◽  
Mohamed Samy Abd ElAziz ◽  
Mahmoud Tawfik KhalafAllah ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Statistical Significance ◽  
Case Series ◽  
Cross Linking ◽  
Case Series Study ◽  
Corrected Distance Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Manual Group ◽  
Red Flag ◽  
Dissection Techniques

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

scholarly journals Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus

2016 ◽  
Vol 5 (2) ◽  
pp. 71-76
Author(s):  
Igor Kaiserman ◽  
Lily Karmona ◽  
Tzahi Sela ◽  
Oz Franco ◽  
Avi Shoshani ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Contact Lenses ◽  
Cross Linking ◽  
Visual Rehabilitation ◽  
Surface Ablation ◽  
Uncorrected Visual Acuity ◽  
Promising Treatment ◽  
Functional Vision ◽  
Collagen Cross Linking

ABSTRACT Purpose In this article, we present the results of eight eyes of patients who underwent combined same-day partial topography-guided surface ablation followed by accelerated collagen cross-linking (CXL) procedure at Care-Vision Laser Centers to achieve stabilization of corneal ectasia and enhance visual rehabilitation in keratoconus. Materials and methods A retrospective nonrandomized review of 8 eyes of 6 patients who underwent the Athens Protocol for progressive keratoconus. Each patient underwent topography-guided ablation followed by CXL procedure. Follow-up Follow-up was done on day 1, day 7, and then at 1, 3, 6, and 12 months. Results There was a rapid and significant improvement in uncorrected visual acuity and best-corrected visual acuity in 100% eyes, a reduction of keratometric values, and symmetry between vertical hemimeridians. Topographic evaluation showed a marked improvement in irregularity. There were no signs of keratoconic progression noted in any of the eyes on last follow-up. No adverse events were reported in any patient. Conclusion Simultaneous surface ablation + CXL seems to be a promising treatment capable of offering patients functional vision and halting progression of the disorder. Precis Simultaneous topography-guided custom ablation treatment and photorefractive keratectomy with CXL offers keratoconic patients intolerant to contact lenses both stabilization of the cornea and improved functional vision with spectacles correction. How to cite this article Karmona L, Sela T, Franco O, Shoshani A, Munzer G, Kaiserman I. Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):71-76.

Corneal collagen cross-linking for management of keratoconus in patients affected by Tourette syndrome

2020 ◽  
pp. 112067212094510
Author(s):  
Karl Anders Knutsson ◽  
Giorgio Paganoni ◽  
Oriella Ambrosio ◽  
Giulio Ferrari ◽  
Paolo Rama
Keyword(s):  
Visual Acuity ◽  
Tourette Syndrome ◽  
Case Series ◽  
Young Male ◽  
Cross Linking ◽  
Male Patients ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose: To present a series of two patients affected by Tourette syndrome (TS) and progressive keratoconus. Case series: Two young male patients with keratoconus and TS were referred to our center. In both patients eye rubbing was present and in one patient, an ocular tic was present determining blepharospasm. Progression of keratoconus occurred in both cases and corneal collagen cross-linking (CXL) was performed. All treated eyes showed topographic stability with stable refraction and conserved visual acuity, with a follow-up period ranging from 1.5 to 2.5 years. Conclusion: Patients with keratoconus and TS should be observed frequently to document topographical and refractive changes, and in case of progressing disease, CXL should be performed in order to prevent further progression.

Corneal collagen cross-linking with and without simultaneous intrastromal corneal ring segment implantation: One-year pilot study

2019 ◽  
pp. 112067211988787 ◽  
Author(s):  
Indra Prasad Sharma ◽  
Ramendra Bakshi ◽  
Monica Chaudhry
Keyword(s):  
Visual Acuity ◽  
Confidence Interval ◽  
Randomized Study ◽  
Cross Linking ◽  
Intrastromal Corneal Ring ◽  
Ring Segment ◽  
One Year ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Aim: The aim of this study was to assess and compare the visual, refractive, and topographic outcomes of keratoconic eyes treated with corneal collagen cross-linking combined with and without same day intrastromal corneal ring segment over the first 12 months. Methods: This prospective randomized study analyzed 38 eyes of 30 consecutive keratoconus patients aged 26.21 ± 6.97 (range = 15–41) years. A total of 20 eyes were treated with collagen cross-linking alone, and 18 eyes underwent collagen cross-linking combined with simultaneous femtosecond laser-assisted intrastromal corneal ring segment. Visual acuity, manifest refraction, and corneal topography (using a rotating Scheimpflug topographer) were assessed and compared between the two groups at baseline, 6, and 12 months. Results: On an average follow-up duration of 12.2 ± 0.50 (range = 11–13) months, both collagen cross-linking alone and collagen cross-linking with simultaneous intrastromal corneal ring segment implantation were effective. However, collagen cross-linking plus intrastromal corneal ring segment resulted in an additional improvement of uncorrected distance visual acuity of 0.16 (95% confidence interval = 0.01 to 0.32) logarithm of the minimum angle of resolution units (p = 0.035), cylindrical power by 1.16 D (95% confidence interval = 0.25 to 2.06, p = 0.014), and spherical equivalent by 1.40 D (95% confidence interval = −2.71 to −0.08, p = 0.038) at 1 year. During the study period, no serious intraoperative or postoperative complications were noted in either group. Conclusion: One-year follow-up results suggest that collagen cross-linking with simultaneously combined intrastromal corneal ring segment implantation could yield an additive visual and refractive outcome. The combined procedure is safe and merits consideration for the treatment of progressive keratoconus to achieve better visual rehabilitation.

scholarly journals Combined Intacs SK and Corneal Collagen Cross-linking for the Treatment of Keratoconus

2012 ◽  
Vol 1 (2) ◽  
pp. 109-116 ◽  
Author(s):  
Hanna Garzozi
Keyword(s):  
Visual Acuity ◽  
Combined Treatment ◽  
Cross Linking ◽  
Corneal Resistance Factor ◽  
Corrected Visual Acuity ◽  
Manifest Refraction ◽  
Uncorrected Visual Acuity ◽  
Significant Change ◽  
Collagen Cross Linking ◽  
Corneal Collagen

ABSTRACT Purpose To evaluate the efficacy of the combined treatment of Intacs SK (Severe keratoconus) and corneal collagen cross- linking in the management of advanced keratoconus (KC). Setting Private laser center, Haifa, Israel. Affiliated to Hadassah Hospital, Jerusalem. Methods This is a retrospective study. Intacs SK were implanted using manual technique in eyes with moderate-to- severe keratoconus followed by collagen corneal cross-linking (CXL). Evaluation included uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction, slit-lamp examination and corneal topography. Ocular response analyzer (ORA) was used to assess the corneal hysteresis (CH) and the corneal resistance factor (CRF). Results We report on improvement of the UCVA, BSCVA, decrease in myopia, astigmatism and keratometry readings. No significant change in CRF or CH was noted. Conclusion The combined treatment of Intacs SK and corneal CXL for the treatment of advanced keratoconus is safe and effective. The combined treatment resulted in improved UCVA, BSCVA, keratometry readings and regularization of the topography but no significant change in CRF and HS. How to cite this article Barbara R, Garzozi H, Barbara A. Combined Intacs SK and Corneal Collagen Cross-linking for the Treatment of Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):109-116.

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

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Sherif A. Eissa ◽  
Nashwa Badr Eldin ◽  
Ashraf Ahmed Nossair ◽  
Wael Ahmed Ewais
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Cross Linking ◽  
Corneal Densitometry ◽  
Corrected Distance Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Concentric Zone ◽  
Baseline Values ◽  
The Mean

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

scholarly journals Bandage Therapeutic-Optical Keratoplasty in Keratoconus Patients after Intrastromal Corneal Segments Implantation

2019 ◽  
Vol 16 (3) ◽  
pp. 283-288
Author(s):  
G. A. Osipyan ◽  
V. M. Sheludchenko ◽  
N. Y. Youssef ◽  
Kh. Khraystin
Keyword(s):  
Visual Acuity ◽  
Past History ◽  
Functional Results ◽  
Intrastromal Corneal Ring ◽  
Uncorrected Visual Acuity ◽  
Long Term Follow Up ◽  
History Of ◽  
Optical Zone

Purpose — to evaluate the functional results of bandage therapeutic-optical keratoplasty (BTOK) in keratoconus eyes after implantation of intrastromal corneal ring segments (CRS). Material and methods. The study included 18 patients with stage II and III keratoconus (as per Amsler-Krumeich classification) who had underwent implantation of CRS with unsatisfactory long-term outcomes. The patients were divided into two groups. The first group consisted of 7 patients (7 eyes) of 27 ± 3 years old with had past history of CRS implantation followed by the absence of predicted improvement of visual acuity during the observation period of up to 18 months. The second group included 11 patients (11 eyes) who had visual acuity improvements after CRS implantation, but had regression in the long-term follow-up of 2 to 5 years. The surgical algorithm consisted of two steps: first, all 18 patients had the intrastromal ring segments removed; second, 3 months later they underwent BTOK. Outcomes. After the removal of CRS, patients of both groups showed improvements in central corneal refraction, their visual acuity decreased to 0.07 ± 0.02 and 0.09 ± 0.04, respectively. The 36 months follow-up after BTOK revealed significant improvements in visual acuity — up to 0.48 ± 0.04 and 0.54 ± 0.11, respectively — in all patients in both group due to marked flattening of the cornea in the optical zone. Conclusion. Bandage therapeutic-optical keratoplasty allows treatment of patients with complicated or who had unsatisfactory results after implantation of intrastromal ring segments. The surgery leads to stabilization of keratectasia in keratoconus patients and significantly increases uncorrected visual acuity.

scholarly journals Corneal Collagen Cross-Linking Combined with an Artiflex Iris-Fixated Anterior Chamber Phakic Intraocular Lens Implantation in a Patient with Progressive Keratoconus

2017 ◽  
Vol 8 (3) ◽  
pp. 482-488 ◽  
Author(s):  
Sharif Hashmani ◽  
Nauman Hashmani ◽  
Roha Saeed Memon
Keyword(s):  
Visual Acuity ◽  
Anterior Chamber ◽  
Intraocular Lens ◽  
Vision Loss ◽  
Cross Linking ◽  
Phakic Intraocular Lens ◽  
Corrected Visual Acuity ◽  
Uncorrected Visual Acuity ◽  
Collagen Cross Linking ◽  
Corneal Collagen

We present here the case of a 24-year-old male who experienced progressive keratoconus and vision loss which adversely affected his ability to carry out everyday tasks. This landed him in the Hashmanis Hospital for consultation. He had a preoperative best corrected visual acuity of 6/12. He underwent multiple Oculus Pentacam examinations, which showed progressive keratoconus. Corneal collagen cross-linking (CXL) was performed to stabilize his cornea and, subsequently, an Artiflex anterior chamber iris-fixated phakic intraocular lens (ACIF-PIOL) was implanted to alleviate his refractive errors. The patient achieved a postoperative uncorrected visual acuity of 6/12. This report shows that CXL combined with ACIF-PIOL can be safe and effective in those with progressive keratoconus.

Long term results of accelerated corneal collagen cross-linking in pediatric keratoconus

2021 ◽  
pp. 112067212110183
Author(s):  
Yasin Cinar ◽  
Cagla Cilem Han ◽  
Alparslan Sahin ◽  
Zeba A Syed
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
University Hospital ◽  
Long Term Results ◽  
Cross Linking ◽  
Distance Visual Acuity ◽  
The Mean ◽  
Collagen Cross Linking ◽  
Corneal Collagen

Purpose: To evaluate the long term visual, refractive, and corneal tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACXL) in the management of pediatric keratoconus (KC). Methods: This retrospective study included patients under 18 years old with progressive KC who underwent ACXL between 2012 and 2019 at Dicle University Hospital. Complete ophthalmic examination was performed including uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Evaluations were performed preoperatively and at 6 months intervals postoperatively. Results: Forty-nine eyes of 49 patients were included in the study. The mean age of patients at the time of ACXL was 14.2 ± 1.8 (range: 9.5–17.3) years. Mean follow up was 4.61 ± 1.90 (range: 2.0–8.1) years. The mean LogMAR UDVA improved from 0.94 ± 0.41 to 0.81 ± 0.43, 0.69 ± 0.41, and 0.67 ± 0.33 after 1, 3, and 5 years respectively ( p = 0.001). The mean LogMAR CDVA improved from 0.58 ± 0.36 to 0.46 ± 0.31, 0.34 ± 0.23, and 0.39 ± 0.27 after 1, 3, and 5 years respectively ( p = 0.015). The mean refractive cylinder improved significantly from 6.01 ± 2.07 diopters (D) to 5.46 ± 1.87, 5.38 ± 2.18, and 5.02 ± 2.31 D after 1, 3, and 5 years respectively ( p = 0.005). As compared to preoperative values, steep keratometry and maximum keratometry were not significantly different ( p = 0.805 and 0.448, respectively) following ACXL, while flat keratometry significantly improved after ACXL ( p = 0.012). Although central corneal thicknesses decreased significantly ( p = 0.029), the decrease in thinnest corneal thickness was not statistically significant ( p = 0.205). Conclusion: Epithelium-off ACXL seems to be effective for halting KC progression with long term clinical benefits in pediatric patients.

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

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

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

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