The Intrastromal Corneal Ring in Penetrating Keratoplasty—Long-term Results of a Prospective Randomized Study

Birnbaum, Florian; Schwartzkopff, Johannes; Böhringer, Daniel; Reinhard, Thomas

doi:10.1097/ico.0b013e318206caa9

Cited by 16 publications

(11 citation statements)

References 17 publications

(19 reference statements)

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“…Compared to other techniques, undercorrection and, rarely, overcorrection have also been reported for almost all corneal refractive surgical methods of correcting post-PKP myopia and astigmatism including incisional surgeries [ 12 ], photoablation (PRK or LASIK) [ 19 – 26 ], and ICR implantation [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Intracorneal ring segment (ICR) implantation has recently been reported in post-PKP eyes but with significant undercorrection and low predictability compared to their results in keratoconic eyes. Immune reaction induction leading to graft rejection and ring migration and perforation into the anterior chamber are possible complications that can violate the future integrity of the grafted cornea [ 1 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism

Massoud

Ibrahim

Shehata³

et al. 2016

Journal of Ophthalmology

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Purpose. To evaluate the visual and refractive outcomes after small incision lenticule extraction (SMILE) for treating myopia and myopic astigmatism after penetrating keratoplasty (PKP). Design. Case-series. Methods. Ten eyes of 10 patients with previous PKP and residual myopic astigmatism for whom pentacam imaging and thickness measurements were acceptable for laser vision correction. Manifest refraction (MR), uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were obtained preoperatively and one day, one week, and one, 3, and 6 months postoperatively. Cases were operated on the VisuMax® femtosecond laser platform with 500 kHz repetition rate. Results. The mean correction ratio for spherical errors was 0.84 ± 0.19 D and for the mean refractive spherical equivalent (MRSE) was 0.79 ± 0.13 D. Vector analysis showed a mean astigmatism reduction at the intended axis of 67 ± 25.25%, a correction index of 0.81 ± 0.21, and an overall mean percentage of success of astigmatism surgery of 53 ± 37.9%. The postoperative MRSE was stable throughout the 6-month follow-up period. The efficacy index was 0.93 and the safety index was 1.12. Conclusion. SMILE for correction of post-PKP myopia and astigmatism is effective, safe, and stable with moderate accuracy and predictability. Centration of the treatment within the grafts was easily performed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism

Massoud

Ibrahim

Shehata³

et al. 2016

Journal of Ophthalmology

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“…This undercorrection can be related to PKP corneas being more rigid with normal thickness and elasticity compared to corneas of keratoconus that are thinner and more elastic [6]. The ICRS implantation can have several complications affecting the results and might not achieve the correction of the astigmatism; examples would be spontaneous suture rupture, immune reactions, and migration of ICRS [15]. The consideration of ICRS was mainly based on the patient having a thin cornea and the aim of correcting the astigmatism.…”

Section: Discussionmentioning

confidence: 99%

Management of Extreme Ametropia after Penetrating Keratoplasty: A Series of Surgical Procedures for High Myopia and Astigmatism

Valdez-García

Cueto-Gómez²,

Lozano-Ramírez³

et al. 2014

Case Rep Ophthalmol

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A series of surgical interventions - relaxing corneal incisions, intraocular lens, and intrastromal rings - were used to correct a case of extreme ametropia in a thin cornea after a penetrating keratoplasty in an 18-year-old patient who presented with a -10.25 -8.50 × 120 preoperative refraction and 20/200 best-corrected visual acuity (BCVA). After a series of surgical procedures, the patient's BCVA in his left eye improved to 20/30 with +0.50 -1.00 × 170, the slit lamp examination showed no significant findings, and the patient's visual complaints disappeared. At the 1-year follow-up, the BCVA was 20/25, without visual complaints. The process of individualizing the surgical procedure in the present case was employed in an outcome-based approach, that is, the next surgical procedure was defined after the surgery and postoperative evaluation. The patient did not present complications during the follow-up period of 2.5 years.

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“…In a prospective randomized study in 2011, Birnbaum et al 19 reported no significant reduction of postoperative astigmatism as well as three immune reactions in the group of ring implantation. In the same study, nylon suture rupture occurred in five out of nine patients which worsened the postoperative astigmatism, speaking against the efficacy of the titan ring.…”

Section: Discussionmentioning

confidence: 98%

Need for explantation of an intrastromal titan ring after penetrating keratoplasty in two patients

Xanthopoulou

Milioti

Seitz

2020

European Journal of Ophthalmology

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The most severe complications after penetrating keratoplasty (PKP) include high astigmatism and immunological graft reaction. The introduction of the corneal intrastromal titan ring by Krumeich intended to reduce the incidence of both complications. We present two patients with keratoconus who referred to our department after a PKP combined with the implantation of an intrastromal ring. The first patient suffered from bulbar pain and headaches. The second patient suffered from postoperative high myopia, irregular astigmatism and was contact lens intolerant. In the first patient we recognized anterior movement of the ring inside the stroma and decided to remove it. The second patient was found to have extreme bulging of the transplant. We removed the ring and sequentially performed a repeat-PKP. In both patients the implantation of the ring failed to decrease the postoperative astigmatism and caused symptoms that affected the patients’ everyday life. Therefore, we recommend not to use this titan ring.

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The Intrastromal Corneal Ring in Penetrating Keratoplasty—Long-term Results of a Prospective Randomized Study

Abstract: The use of the intrastromal corneal ring after penetrating keratoplasty caused no reduction in postoperative astigmatism. However, its use was statistically significantly associated with adverse events.

Cited by 16 publications

References 17 publications

Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism

Small Incision Lenticule Extraction for Postkeratoplasty Myopia and Astigmatism

Management of Extreme Ametropia after Penetrating Keratoplasty: A Series of Surgical Procedures for High Myopia and Astigmatism

Need for explantation of an intrastromal titan ring after penetrating keratoplasty in two patients

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