Comparison of Intrastromal Corneal Ring Segment Implantation only and in Combination with Collagen Crosslinking for Keratoconus

Çakir, Hanefi; Pekel, Gökhan; Perente, İrfan; Genç, Selim

doi:10.5301/ejo.5000250

Cited by 22 publications

(36 citation statements)

References 26 publications

(49 reference statements)

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“…Again, comparing the results after the procedures, no statistically significant differences were found. This finding is in accordance with the established absence of a statistical difference in the outcomes between the two treatment strategies, already demonstrated by other authors [14]. As keratoconus is a progressive ectatic disease, reinforcing corneal biomechanical properties with corneal collagen CXL could help to stabilize the corneal ectasia on the longterm [15][16][17].…”

Section: Discussionsupporting

confidence: 91%

“…These findings suggest that this combination may be an effective and safe treatment for keratoconus correction [19]. Furthermore, the comparison between ICRS implantation only and in combination with corneal collagen CXL has demonstrated similar improvement rates in visual acuity, spherical and cylindrical errors and mean keratometry values [14].…”

Section: Discussionmentioning

confidence: 78%

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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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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 78%

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

et al. 2020

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“…The combination of crosslinking with other procedures attempting to alter the corneal shape has had various degrees of success. Excimer laser treatment shows promising results (Cheema et al 2012;Kremer et al 2012), and implantation of intrastromal ring segments is also beneficial (Coskunseven et al 2009), although the contribution of crosslinking to the summarized effect may not have been fully elucidated (Cakir et al 2013). In thermokeratoplasty (Kymionis et al 2010) or microwave treatment (Vega-Estrada et al 2012), the corneal stiffening effect from CXL, using the current treatment regimen, is insufficient to maintain the initial corneal flattening and significant regression occurs.…”

Section: Discussionmentioning

confidence: 99%

Initial results from mechanical compression of the cornea during crosslinking for keratoconus

Rehnman

Behndig

Hallberg

et al. 2014

Acta Ophthalmologica

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ABSTRACT.Purpose: To compare refractive changes after corneal crosslinking with and without mechanical compression of the cornea. Methods: In a prospective, open, randomized case-control study conducted at the Department of Ophthalmology, Ume a University Hospital, Sweden, sixty eyes of 43 patients with progressive keratoconus aged 18-28 years planned for corneal crosslinking and corresponding age-and sex-matched control subjects were included. The patients were randomized to conventional corneal crosslinking (CXL; n = 30) or corneal crosslinking with mechanical compression using a flat rigid contact lens sutured to the cornea during treatment (CRXL; n = 30). Subjective refraction and ETDRS best spectacle-corrected visual acuity (BSCVA), axial length measurement, keratometry and pachymetry were performed before and 1 and 6 months after treatment. Results: The keratoconus patients had poorer BSCVA, higher refractive astigmatism and higher keratometry readings than the control subjects at baseline (p < 0.01). In the CXL group, BSCVA increased from 0.19 AE 0.26 to 0.14 AE 0.18 logMar (p = 0.03), and the spherical equivalent improved from À1.9 AE 2.8 D to À1.4 AE 2.4 D (p = 0.03). Maximum keratometry readings decreased after CXL from 53.1 AE 4.9 D to 52.6 AE 5.2 D (p = 0.02), and the axial length decreased in the CXL group, likely due to post-treatment corneal thinning (p = 0.03). In the CRXL group, all the above variables were unaltered (p > 0.05). Conclusion: At 6 months, the refractive results from CRXL did not surpass those of conventional CXL treatment. Rather, some variables indicated a slightly inferior effect. Possibly, stronger crosslinking would be necessary to stabilize the cornea in the flattened configuration achieved by the rigid contact lens.

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“…Moreover, it was reported that after one or both ring explantations, the refractive effects may be stable or reversible while the topographic changes seem to be maintained [96][97][98][99] . Therefore, while collagen crosslinking can be performed before, in conjunction with, or after ICRS implantation, the ideal method for combining these two treatments is still undefined.…”

Section: And Intracorneal Ringsmentioning

confidence: 99%

Corneal Collagen Crosslinking with Riboflavin and Ultraviolet - A Irradiation in the Management of Progressive Ectatic Corneal Disorders. Review Article

Eldine

2017

Journal of Ophthalmology and Related Sciences

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Corneal crosslinking (CXL) has been proposed as a new modality to stop progression of keratoconus or secondary corneal ectasia, aiming to prevent progressive visual loss and to delay or avoid corneal transplantation. The possibility of strengthening corneal tissue by means of a photochemical reaction of corneal collagen by the combined action of riboflavin and ultraviolet-A irradiation (UVA), radically modified the conservative management of progressive corneal ectasia. This is a review of the state of the art of CXL. The paper describes basic principles, advantages and limitations of different CXL techniques and possible future evolution of the procedure.

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Comparison of Intrastromal Corneal Ring Segment Implantation only and in Combination with Collagen Crosslinking for Keratoconus

Abstract: Both combined ICRSI-CXL and ICRSI-only groups experienced favorable outcomes, without statistical difference in any studied effect of both treatment strategies.

Cited by 22 publications

References 26 publications

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

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

Initial results from mechanical compression of the cornea during crosslinking for keratoconus

Corneal Collagen Crosslinking with Riboflavin and Ultraviolet - A Irradiation in the Management of Progressive Ectatic Corneal Disorders. Review Article

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