Predictability of Tunnel Depth for Intrastromal Corneal Ring Segments Implantation Between Manual and Femtosecond Laser Techniques

Monteiro, Tiago; Alfonso, José F.; Franqueira, Nuno; Faria-Correia, Fernando; Ambrósio, Renato; Madrid-Costa, David

doi:10.3928/1081597x-20180108-01

Cited by 28 publications

(29 citation statements)

References 21 publications

(28 reference statements)

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“…A recent study reported a higher accuracy and predictability of femtosecond laser for the creation of intrastromal tunnel compared to the manual technique. 7 Hence, it seems appropriate to analyse if those results have impact on the visual and refractive outcomes of the ICRS implantation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical outcomes between manual and femtosecond laser techniques for intrastromal corneal ring segment implantation

Monteiro

Alfonso

Franqueira

et al. 2019

European Journal of Ophthalmology

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Purpose: The purpose was to compare the visual, refractive and aberrometric results of intrastromal corneal ring segments implantation with manual dissection and femtosecond laser–assisted surgery. Methods: This is a multicentre study, which included consecutive patients with paracentral keratoconus, in which the difference between the axes of the topographic flattest and the coma aberration was <60°, who had Ferrara-type intrastromal corneal ring segment implantation using manual dissection or femtosecond laser technique. LogMAR uncorrected (uncorrected distance visual acuity) and corrected (corrected distance visual acuity) distance visual acuity, refractive errors and the root mean square for corneal coma-like aberration were recorded before and at 6 months after surgery. Results: The study included 84 and 110 eyes in the manual group and in the femtosecond group, respectively. After surgery, there was a statistically significant improvement in uncorrected distance visual acuity and corrected distance visual acuity for both groups ( p < 0.0001), and there were no statistically significant differences between groups ( p > 0.3). For both groups, there was a reduction in spherical equivalent after intrastromal corneal ring segment implantation ( p < 0.0001). There were no statistically significant differences between groups in the magnitude of spherical equivalent reduction ( p = 0.34) The magnitude of the root mean square coma-like reduction was 0.93 ± 0.76 and 0.83 ± 0.80 μm in the manual and femtosecond group, respectively ( p = 0.2). While in the femtosecond laser group no complications were reported, in the manual group, the intraoperative or postoperative complications rate was 13.09%. Conclusion: Although both surgical techniques provide comparable visual, refractive and aberrometric outcomes, it should be noted that the femtosecond laser is a safer surgical procedure, with no complications reported.

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Section: Introductionmentioning

confidence: 99%

Comparison of clinical outcomes between manual and femtosecond laser techniques for intrastromal corneal ring segment implantation

Monteiro

Alfonso

Franqueira

et al. 2019

European Journal of Ophthalmology

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“…19 Only Kouassi et al 35 found in a prospective comparative study that both mechanical and femtosecond laser-assisted Intacs implantations showed a more superficial ring segment placement than predicted, with no statistically significant difference between techniques. Differences in the sample evaluated and in the clinical and surgical protocols followed in this study and in the study of Monteiro et al, 26 and by our research group in the current series may account for this discrepancy.…”

Section: Discussionmentioning

confidence: 55%

“…This is consistent with the results of previous studies showing a high level of accuracy in the lamellar dissection achieved with the femtosecond laser. [26][27][28] Monteiro et al 26 found in a multicenter comparative study that ICRS implantation assisted by a femtosecond laser was a more precise procedure in terms of dissection depth when compared with the manual dissection technique. Naftali and Jabaly-Habib 29 found that the depth of implantation of ICRS measured by OCT was less than expected when the mechanical technique was used for ring segment implantation.…”

Section: Discussionmentioning

confidence: 99%

Effect of the variability in implantation depth of intracorneal ring segments using the femtosecond laser technology in corneal ectasia

Peris-Martínez

Dualde-Beltrán

Fernández-López

et al. 2019

European Journal of Ophthalmology

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Purpose: To analyze the impact of the depth of implantation of intracorneal ring segments on morphological, biomechanical, and clinical outcomes in ectatic corneas. Methods: This prospective longitudinal study enrolled 40 eyes of 29 patients (age 20–51 years) with corneal ectasia that underwent intracorneal ring segments implantation (KeraRing, Mediphacos). Changes in visual acuity, refraction, corneal tomography, and corneal biomechanics (Ocular Response Analyzer, Reichert) were evaluated during a 6 month follow-up. Likewise, changes in ring segment implantation depth measured by optical coherence tomography (Visante OCT, Carl Zeiss Meditec) were also evaluated. Results: Mean relative depth of implantation was 71.6 ± 5.8%, 71.5 ± 6.5%, and 71.9 ± 6.3% at 1, 3, and 6 months after surgery, respectively (p = 0.827). The difference between the real relative depth of implantation and the theoretical attempted value of 70% was not statistically significant (p = 0.072). Differences in spherical equivalent during the follow-up changed significantly depending on the level of relative depth of implantation (p = 0.036), with an increase of 0.114 D per each 1% increase in relative depth of implantation. Likewise, a decrease of –0.194 D in the steepest keratometric reading was found per each decrease of 1% in relative depth of implantation (p = 0.026). Changes in corneal thickness (p = 0.092) and biomechanics (p = 0.080) were not related to relative depth of implantation. Conclusion: The effect on visual acuity and refraction of intracorneal ring segments when implanted in corneal ectasia is less clinically relevant when the implantation is done at a very deep plane. The variability of the depth of intracorneal ring segments implantation when using femtosecond laser technology is minimal and with no clinically significant effect on clinical outcomes.

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“…OCT can help to accurately determine the thickness of the cornea at the site of ring placement pre‐, intra‐ and post‐operatively (Figure ) . Pre‐operatively, OCT can quantitatively and qualitatively evaluate the corneal stroma before implantation to ensure there is adequate depth for ring placement; intra‐operatively, OCT can be used to assess manual or femtosecond laser created tunnels before implantation of the intrastromal ring . Post‐operatively, OCT can be used to monitor segment migration and depth so that complications can be more readily anticipated …”

Section: Hydropsmentioning

confidence: 99%

Optical coherence tomography imaging in keratoconus

Yip

Chan

2019

Clinical and Experimental Optometry

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Optical coherence tomography (OCT) is being increasingly used as a tool in the diagnosis and management of keratoconus. While elevation-based topography remains essential, there is an expanding role for cross-sectional OCT imaging in the diagnosis of the disease. Images and measurements of corneal thickness, and in particular, epithelial thickness, may be important in diagnosing early cases, and following procedures such as intrastromal corneal ring segments, corneal transplants and corneal collagen cross-linking.

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Predictability of Tunnel Depth for Intrastromal Corneal Ring Segments Implantation Between Manual and Femtosecond Laser Techniques

Cited by 28 publications

References 21 publications

Comparison of clinical outcomes between manual and femtosecond laser techniques for intrastromal corneal ring segment implantation

Comparison of clinical outcomes between manual and femtosecond laser techniques for intrastromal corneal ring segment implantation

Effect of the variability in implantation depth of intracorneal ring segments using the femtosecond laser technology in corneal ectasia

Optical coherence tomography imaging in keratoconus

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