One-Year Clinical Outcomes of a Two-Step Surgical Management for Keratoconus—Topography-Guided Photorefractive Keratectomy/Cross-Linking After Intrastromal Corneal Ring Implantation

Al-Tuwairqi, Waleed; Osuagwu, Uchechukwu L.; Razzouk, Haya; Ogbuehi, Kelechi C.

doi:10.1097/icl.0000000000000135

Cited by 25 publications

(41 citation statements)

References 31 publications

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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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“…Several authors report an improvement in the quality of vision and possibly contact lens fit due to corneal surface regularization. [2][3][4] This technique has also been evaluated for refractive surgery, particularly for complications such as decentration or difficult revision surgery. 5 For the management of corneal scarring, topography-guided custom ablation treatment was expected to become a valuable option, combining photoablation of the fibrotic tissue and regularization of the corneal surface.…”

Section: Discussionmentioning

confidence: 99%

Topography-guided transepithelial photoablation for the treatment of interstitial keratitis sequelae

Loriaut

Jouve

Temstet

et al. 2015

Journal of Cataract and Refractive Surgery Online Case Reports

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“…All of these studies reported significant improvement in visual acuity, refraction, and corneal shape. This triple procedure can be performed in 2-stage ICRS implantation followed by simultaneous PRK and corneal CXL [ 127 – 130 ] or in a three-step procedure ICRS implantation followed by corneal CXL and PRK 6 months later [ 131 , 132 ].…”

Section: Combined Proceduresmentioning

confidence: 99%

Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality

Fernández-Vega-Cueto

Romano

Zaldivar

et al. 2017

Journal of Ophthalmology

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Keratoconus provides a decrease of quality of life to the patients who suffer from it. The treatment used as well as the method to correct the refractive error of these patients may influence on the impact of the disease on their quality of life. The purpose of this review is to describe the evidence about the conservative surgical treatment for keratoconus aiming to therapeutic and refractive effect. The visual rehabilitation for keratoconic corneas requires addressing three concerns: halting the ectatic process, improving corneal shape, and minimizing the residual refractive error. Cross-linking can halt the disease progression, intrastromal corneal ring segments can improve the corneal shape and hence the visual quality and reduce the refractive error, PRK can correct mild-moderate refractive error, and intraocular lenses can correct from low to high refractive error associated with keratoconus. Any of these surgical options can be performed alone or combined with the other techniques depending on what the case requires. Although it could be considered that the surgical option for the refracto-therapeutic treatment of the keratoconus is a reality, controlled, randomized studies with larger cohorts and longer follow-up periods are needed to determine which refractive procedure and/or sequence are most suitable for each case.

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One-Year Clinical Outcomes of a Two-Step Surgical Management for Keratoconus—Topography-Guided Photorefractive Keratectomy/Cross-Linking After Intrastromal Corneal Ring Implantation

Cited by 25 publications

References 31 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

Topography-guided transepithelial photoablation for the treatment of interstitial keratitis sequelae

Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality

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