Femtosecond Laser and Mechanical Dissection for ICRS and MyoRing Implantation: A Meta-Analysis

Struckmeier, Ann-Kristin; Hamon, Loïc; Flockerzi, Elias; Munteanu, Cristian; Seitz, Berthold; Daas, Loay

doi:10.1097/ico.0000000000002937

Cited by 10 publications

(11 citation statements)

References 47 publications

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“…Since 1991 and the first ICRS implanted in humans [36], significant improvements in design [25], tunnel creation [37], and segment insertion techniques have led to better postsurgical outcomes [10] and reduction of complications [21].…”

Section: Discussionmentioning

confidence: 99%

“…ICRS implantation is associated with potential complications such as infectious keratitis, asymmetric or superficial segment displacement, segment extrusion, posterior corneal perforations, corneal stromal edema around the incision, extension of the incision towards the central visual axis, halos, and glares [10,20]. These complications have become rarer since the tunnel creation for the insertion of ICRS is no longer performed mechanically but commonly carried out using femtosecond laser (Fs laser) [20,21]. Besides these complications, intrastromal structural changes such as peri-segmental fibrosis [22] and intrastromal lamellar channel deposits have been observed with slit lamp, in vivo confocal microscopy and optical coherence tomography [4,[23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

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Morphological characterization and clinical effects of stromal alterations after intracorneal ring segment implantation in keratoconus

Hamon

Schlötzer‐Schrehardt

Flockerzi

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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Purpose To analyze the histological and (ultra)structural stromal tissue changes after femtosecond (Fs) laser–assisted intracorneal ring segment (ICRS) implantation and their refractive and topographic effects in patients with keratoconus. Methods This monocentric retrospective case series included 15 consecutive patients with clinical peri-segmental lamellar channel deposits after treatment with Fs-ICRS implantation for keratoconus. The stromal changes were investigated using in vivo confocal microscopy. Two patients underwent a penetrating keratoplasty after the Fs-ICRS implantation; the explanted corneas were processed for histopathology and transmission electron microscopy (TEM). Refractive and topographic effects were investigated comparing the uncorrected (UDVA) and corrected (CDVA) distance visual acuity, spherical equivalent (SE), flat (K1), steep (K2), and steepest (Kmax) keratometry before and after detection of lamellar channel deposits. Results In vivo confocal microscopy revealed diffuse linear and focal granular hyperreflective structures. Histologically, there was mild proliferation of fibroblasts and fibrosis. TEM demonstrated focal accumulations of degenerated keratocytes with cytoplasmic lipid inclusions. There were no significant changes for UDVA (Δ = 0.0 ± 0.2 logMAR; p = 0.67), CDVA (Δ = 0.0 ± 0.1 logMAR; p = 0.32), SE (Δ 0.1 ± 0.9 D; p = 0.22), K1 (Δ = 0.3 ± 1.0 D; p = 0.28), K2 (Δ = 0.1 ± 0.9 D; p = 0.51), and Kmax (Δ = 0.3 ± 1.5 D; p = 0.17). Conclusions Two types of structural stromal changes were identified: (1) diffuse peri-segmental fibrosis and (2) lamellar channel deposits. These structural changes showed no evidence of a relevant refractive or topographic effect.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Morphological characterization and clinical effects of stromal alterations after intracorneal ring segment implantation in keratoconus

Hamon

Schlötzer‐Schrehardt

Flockerzi

et al. 2022

Graefes Arch Clin Exp Ophthalmol

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“…The Fs laser technology (IntraLase FS laser; Johnson & Johnson Vision, Santa Ana, CA) with a pulse energy of 1.5 mJ was used to create a circular tunnel (360 degrees) into the deep corneal stroma and the incision to insert the ICRS. 12 The insertion of ICRS was performed manually under topical anesthesia. ICRS thickness and arc length was adapted individually according to the manufacturer's nomogram (AJL Ophthalmic S.A., Minao, Spain), depending on the patient's preoperative corneal astigmatism, ectasia topographic phenotype, and coma.…”

Section: Methodsmentioning

confidence: 99%

Implantation of Intracorneal Ring Segments in Keratectasia: Effects on Corneal Biomechanics in 112 Eyes

Hamon,

Pfahl,

Flockerzi

et al. 2023

Cornea

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Purpose: The aim of this study was to analyze changes in corneal biomechanical properties after implantation of intracorneal ring segments (ICRSs) in keratectasia. Methods: This retrospective single-center study included 112 patient eyes that underwent femtosecond laser-assisted ICRS implantation (Intacs SK; Addition Technology Inc, Des Plaines, IL) for keratectasia. Biomechanical analysis was performed using the Ocular Response Analyzer (ORA; Reichert Inc, Depew, NY), with determination of corneal resistance factor, corneal hysteresis, and Keratoconus Match Index, as well as by Corvis ST (OCULUS, Wetzlar, Germany), with determination of stiffness parameter A1, Ambrosio relational thickness to the horizontal profile (Arth), integrated radius, deformation amplitude ratio, and stress–strain index as well as Corvis Biomechanical Index and Tomographic Biomechanical Index. Data collection was performed preoperatively and 6 months postoperatively for ORA and Corvis ST and additionally after 1 and 2 years for ORA. Results: The corneal resistance factor decreased significantly postoperatively (5.8 ± 1.7 mm Hg) compared with preoperatively (6.75 ± 3.7 mm Hg; P = 0.021) and increased again during follow-up (6.2 ± 1.9 mm Hg; P = 0.024), without regaining preoperative values. Corneal hysteresis and Keratoconus Match Index did not change significantly. Stiffness parameter A1 (P = 0.045) increased significantly after ICRS implantation and Arth decreased significantly from 181 ± 85 to 150 ± 92 (P = 0.016). However, there was no significant postoperative change for others Corvis parameters. Conclusions: Corneal biomechanical properties showed inconsistent changes after ICRS implantation. Classical corneal biomechanical parameters (using single central air-puff tonometers) do not seem to be suitable for follow-up after ICRS implantation.

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“…There is a clear advantage of fewer intraoperative complications with FSL than traditional manual tunnel creation. [ 43 , 44 ] Complications include corneal perforation, infection, and implant displacement, although rare and significantly less frequent than mechanical techniques. [ 43 , 44 ] Regarding visual, refractive, and aberrometric outcomes, FSL and mechanical techniques offer similar outcomes.…”

Section: Intracorneal Ring Segmentsmentioning

confidence: 99%

“…[ 43 , 44 ] Complications include corneal perforation, infection, and implant displacement, although rare and significantly less frequent than mechanical techniques. [ 43 , 44 ] Regarding visual, refractive, and aberrometric outcomes, FSL and mechanical techniques offer similar outcomes. [ 40 , 41 , 43 , 44 ] A recent similar technique of FSL tunnel creation has been used in conjunction with corneal allogenic intrastromal ring segments as a potential treatment option for corneal ectasias.…”

Section: Intracorneal Ring Segmentsmentioning

confidence: 99%

Femtosecond laser applications in corneal surgery

Mohamed-Noriega,

Morales-Wong,

Navas

et al. 2023

Taiwan J Ophthalmol

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Femtosecond laser (FSL) applications in corneal surgery have increased since its inception. Corneal surgery has undergone a tremendous transformation thanks to the introduction of FSL technology. This laser makes precise, three-dimensional incisions while causing minimal damage to surrounding tissue. This review updates and summarizes current and upcoming FSL applications in corneal surgery, current commercially available FSL, and its respective applications. Refractive surgery applications include laser in-situ keratomileusis flaps, refractive corneal lenticule extraction such as small incision lenticule extraction, astigmatic keratotomy, intracorneal ring segments tunnels for keratoconus including corneal allogenic intrastromal ring segments, and presbyopia treatments with intrastromal pockets for corneal inlays and intrastromal incisions (INTRACOR). Keratoplasty applications include penetrating keratoplasty trephination; superficial and deep anterior lamellar keratoplasty trephination, lamellar dissection, and tunnel creation; posterior lamellar keratoplasty donor and recipient preparation; Bowman layer transplantation donor, and recipient preparation; and stromal keratophakia. Other applications include conjunctival graft preparation in pterygium surgery, and keratopigmentation (corneal tattooing). FSL is a surgical instrument widely used in corneal surgery because it improves reproducibility and safety in many procedures.

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Femtosecond Laser and Mechanical Dissection for ICRS and MyoRing Implantation: A Meta-Analysis

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 10 publications

References 47 publications

Morphological characterization and clinical effects of stromal alterations after intracorneal ring segment implantation in keratoconus

Morphological characterization and clinical effects of stromal alterations after intracorneal ring segment implantation in keratoconus

Implantation of Intracorneal Ring Segments in Keratectasia: Effects on Corneal Biomechanics in 112 Eyes

Femtosecond laser applications in corneal surgery

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