Femtosecond-assisted intrastromal corneal ring implantation for keratoconus treatment: a comparison with crosslinking combination

Ferenczy, Peter Alexander von Harbach; Dalcegio, Maiara; Koehler, Marcela; Pereira, Thiago Silveira; Moreira, Hamílton; Bugmann, Moreira Luciane

doi:10.5935/0004-2749.20150021

Cited by 40 publications

(16 citation statements)

References 19 publications

(30 reference statements)

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“…1). Removal of duplicates and use of the selection criteria reduced the number of articles reporting the evaluation of ICRS in keratoconus to 95 articles 8,14–16,26…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Different Procedures of Intra-Corneal Ring Segment Implantation in Keratoconus: a Systematic Review and Meta-Analysis

d'Azy

Pereira²,

Chiambaretta

et al. 2019

Trans. Vis. Sci. Tech.

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Purpose To evaluate the efficacy of the functional, keratometric, and refractive postoperative parameters of intracorneal ring segment (ICRS) implantation in keratoconus and its association with collagen cross-linking (CXL), photorefractive keratectomy (PRK), and intraocular lenses (IOLs). Methods We conducted a systematic review and meta-analysis on case series published between 2007 and 2017. Results We included 95 case series with a total of 4560 patients. We included 64 studies of the ICRS procedure, 20 studies of ICRS+CXL, 9 studies of ICRS+CXL+PRK, and 5 studies of ICRS+IOL. We demonstrated an overall improvement of all parameters in all procedures. Cylinder was decreased with an overall effect size (ES) of −1.15 (−1.36 to −0.95; I 2 = 93.7%). Corrected distance visual acuity was improved with an overall ES of 0.89 (0.78 to 1.00; I 2 = 81.9%). Maximal keratometry was decreased with an overall ES of 0.98 (0.85 to 1.11; I 2 = 78.9%). ICRS+IOL is the best procedure to improve spherical equivalent and uncorrected distance visual acuity ( P < 0.05) compared with other procedures. ICRSs versus ICRS+CXL are similar in all parameters except for corrected distance visual acuity. ICRS+CXL+PRK is better than ICRS alone in all parameters except for the correction of spherical equivalent. Conclusions Although the quality and strength of the data are questionable, ICRS implantation is an effective strategy to preserve visual function in keratoconic patients. Particularly, ICRS+CXL+PRK could be a low invasive procedure to propose to young keratoconic patients. Translational Relevance To propose an overview of postoperative parameters on each ICRS procedure on keratoconus.

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“…1). Removal of duplicates and use of the selection criteria reduced the number of articles reporting the evaluation of ICRS in keratoconus to 95 articles 8,14–16,26…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Different Procedures of Intra-Corneal Ring Segment Implantation in Keratoconus: a Systematic Review and Meta-Analysis

d'Azy

Pereira²,

Chiambaretta

et al. 2019

Trans. Vis. Sci. Tech.

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“…While CXL stops or slows the progression of the ectatic process, ICRS implantation flattens and regularizes the cornea and thus, several authors are showing more and more interest in the combination of the two techniques, in order to reap the benefits of both. This has a great relevance, considering that ICRS implants do not ensure control of the ectasia and CXL does not affect visual outcome in patients who underwent the ICRS implantation [18]. Moreover, the combination of intracorneal ring segment implantation and corneal collagen CXL has demonstrated to provide a significant improvement in visual acuity, both UDVA and CDVA, and a significant reduction in spherical equivalent refraction and in keratometry readings, without intraoperative or postoperative complications [19].…”

Section: Discussionmentioning

confidence: 99%

Artificial neural network to guide intracorneal ring segments implantation for keratoconus treatment: a pilot study

et al. 2020

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Background: To analyze the clinical results of an artificial neural network (ANN) that has been processed in order to improve the predictability of intracorneal ring segments (ICRS) implantation in keratoconus. Methods: This retrospective, comparative, nonrandomized, pilot, clinical study included a cohort of 20 keratoconic eyes implanted with intracorneal ring segments KeraRing (Mediphacos, Belo Horizonte, Brazil) using the ANN (ANN group) and 20 keratoconic eyes implanted with KeraRing using the manufacturer's nomograms (nomogram group). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) (visual acuity is expressed in decimal value and in LogMAR value in brackets), manifest refraction, corneal topography, tomography, aberrometry, pachymetry and volume analysis (Sirius System. CSO, Firenze, Italy) were performed during the preoperative visit; and the two groups, ANN group and nomogram group, did not differ significantly preoperatively in all of the parameters evaluated. These preoperative values were compared with the results obtained at the third-month visit. Mann-Whitney test and Wilcoxon test were used for the statistical analyses. Results: The spherical equivalent and the keratometric values decreased significantly in both groups. The CDVA improved from 0.60 ± 0.23 (0.22 LogMAR) pre-operatively to 0.73 ± 0.21 (0.14 LogMAR) post-operatively in the ANN group (p < 0.005), and from 0.54 ± 0.19 (0.27 LogMAR) pre-operatively to 0.62 ± 0.19 (0.21 LogMAR) post-operatively in the nomogram group (p < 0.01), with statistically significant difference between the two groups (p < 0.05), being better in the ANN group. Coma-like aberrations decreased significantly in the ANN group, while in the nomogram group they did not change significantly, but no statistically significant difference was found between the two groups. Conclusions: ANN to guide ICRS provides an increase in the visual acuity, reduction in the spherical equivalent and improvement in the optical quality of keratoconus patients. ANN gives better results when compared with the manufacturer's nomograms in terms of better corrected vision and reduction of the coma-like aberrations. The constant inclusion of new cases will make the predictability of ANN increasingly better as the software finetunes its learning.

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“…There are several reports of promising results [ 76 , 77 ] with the combined treatment, although some studies found that the synergistic effect did not prove superior to ICRS implantation alone. For example, Cakir et al [ 78 ] and Ferenczy et al [ 79 ] could not demonstrate superiority of combined ICRS and CXL treatment over ICRS treatment alone.…”

Section: Current Treatment Options and Managementmentioning

confidence: 99%

Keratoconus Treatment Algorithm

et al. 2017

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Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.

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Femtosecond-assisted intrastromal corneal ring implantation for keratoconus treatment: a comparison with crosslinking combination

Cited by 40 publications

References 19 publications

Efficacy of Different Procedures of Intra-Corneal Ring Segment Implantation in Keratoconus: a Systematic Review and Meta-Analysis

Efficacy of Different Procedures of Intra-Corneal Ring Segment Implantation in Keratoconus: a Systematic Review and Meta-Analysis

Artificial neural network to guide intracorneal ring segments implantation for keratoconus treatment: a pilot study

Keratoconus Treatment Algorithm

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