Visual and Tomographic Outcomes of a 300° Arc-length ICRS Implantation in Moderate to Advanced Central Keratoconus

Alfonso, José F.; Torquetti, Leonardo; Fernández-Vega-Cueto, Luis; Allan, B.D.S.; Poo-López, Arancha; Alfonso-Bartolozzi, Belén; Cruz, José de la; Monteiro, Tiago; Madrid-Costa, David

doi:10.3928/1081597x-20210115-01

Cited by 5 publications

(4 citation statements)

References 36 publications

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“…However, in the current study with a short-arc-length ICRS, the flattening in the minimum K was around 1.0 D, whereas in the study by Tzelikis et al 23 with a 340-degree long-arc-length ICRS, the reduction was higher (around 3.0 D). These results could suggest that similar to what occurs for keratoconus treatment, 29 the long-arc-length ICRS could be a better indication for those post-DALK cases, which require a significant corneal flattening in both K minimum and maximum readings and, in this way, decrease corneal prolatism. By contrast, a short-arc-length ICRS should be indicated for those cases with high astigmatism.…”

Section: Discussionsupporting

confidence: 53%

Intrastromal Corneal Ring Segments Implantation After Deep Anterior Lamellar Keratoplasty for Astigmatism Correction: Mid-term and Long-term Follow-up

Alfonso-Bartolozzi

Fernández-Vega-Cueto

Poo-López

et al. 2022

Cornea

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The aim of this study was to assess the long-term outcomes of implanting intrastromal corneal ring segments (ICRSs) using a femtosecond laser for correcting astigmatism in patients who had previous deep anterior lamellar keratoplasty (DALK) throughout a 5-year follow-up period.Methods: This retrospective study included 40 eyes of 40 patients with previous DALK and astigmatism $3.00 D who underwent Ferrara-type ICRS implantation. The manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity (logMAR), and corneal topography were recorded preoperatively and at 6, 12, 36, and 60 months postoperatively. Results:The mean UDVA (logMAR scale) improved from 1.39 6 0.55 preoperatively to 0.71 6 0.37 at 6 months postoperatively (P , 0.0001). The mean CDVA (logMAR) significantly improved from 0.36 6 0.17 to 0.22 6 0.12 at 6 months after surgery (P , 0.0001). Both UDVA and CDVA remained unchanged throughout the follow-up (P = 0.09). Postoperatively, no eyes lost lines of CDVA compared to preoperatively, and around 80% of the eyes gained lines of CDVA. The safety index remained stable at a value of 1.4 throughout the follow-up. The refractive cylinder decreased from 26.86 6 2.62 D preoperatively to 22.33 6 1.09D at 6 months postoperatively (P , 0.0001), and subsequently, it was stable over the postoperative period (P = 0.2). The maximum and minimum keratometry measurements significantly decreased after surgery and remained stable over the postoperative follow-up period (P . 0.07). Conclusions:This study shows the long-term viability of Ferraratype ICRS implantation using a femtosecond laser as a surgical alternative for astigmatism correction in post-DALK eyes.

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Section: Discussionsupporting

confidence: 53%

Intrastromal Corneal Ring Segments Implantation After Deep Anterior Lamellar Keratoplasty for Astigmatism Correction: Mid-term and Long-term Follow-up

Alfonso-Bartolozzi

Fernández-Vega-Cueto

Poo-López

et al. 2022

Cornea

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“…However, considering that posterior corneal aberrations increase in advanced keratoconus, it should be expected that the posterior coma-like and spherical aberrations were significantly higher before surgery. Besides, our research group has recently shown that long-arc-length intrastromal corneal ring (ICRS) implantation provides significant changes in the anterior and posterior corneal surface morphology of moderate-advanced keratoconus, becoming both surfaces more regular ( 27 ). Although both, ICRS and Neoring, have different indications and mechanisms of action, it seems plausible to expect that Neoring might also have a regularization effect on the recipient bed.…”

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confidence: 99%

A New Pre-descemetic Corneal Ring (Neoring) in Deep Anterior Lamellar Keratoplasty for Moderate-Advanced Keratoconus: A Pilot 2-Year Long-Term Follow-Up Study

et al. 2021

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Purpose: To assess the outcomes of implanting a new polymethylmethacrylate (PMMA) ring (Neoring; AJL Ophthalmic) in pre-descemet deep anterior lamellar keratoplasty (PD-DALK) procedure for moderate-advanced keratoconus.Methods: This prospective study included 10 eyes of 10 patients with moderate-advanced keratoconus who underwent PD-DALK with Neoring implantation. Neoring was implanted in a pre-descemetic pocket. The post-operative examination included refraction, corrected distance visual acuity (CDVA), corneal tomography, and endothelial cell density (ECD). The root mean squares (RMSs) for coma-like aberrations and spherical aberration were evaluated for a pupil size of 4.5 mm. The junctional graft (Tg) and host (Th) thicknesses were measured. The post-operative follow-up was 24 months.Results: Post-operative CDVA was 0.82 ± 0.14 (decimal scale), 100% of the eyes achieved a CDVA of 0.7 (decimal scale). The refractive cylinder was −2.86 ± 1.65 2-years after surgery. No eyes had a post-operative refractive cylinder ≥5.00 D and in five eyes (50%), it was ≤2.50 D. At the last visit, the mean keratometry was 45.64 ± 1.96 D, the RMS for coma-like aberrations was 0.30 ± 0.15 μm and spherical aberration was 0.22 ± 0.09. The mean ECD remains without changes over the follow-up (P = 0.07). At the last visit, Tg and Th were 679.9 ± 39.0 and 634.8 ± 41.2 μm, respectively. The thickness of the complex (host-Neoring) was 740.6 ± 35.6 μm. In all cases, this thickness was thicker than Tg.Conclusion: The results of this study suggest that PD-DALK along Neoring implantation is a viable, effective, and safe option to optimize the post-operative results for moderate-severe keratoconus.

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“…[5][6][7] ICRS has been shown to be very effective in all keratoconus stages; however, it is less effective in more advanced cases. [8][9][10] The advanced keratoconus, on the other hand, requires a more invasive approach, such as deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK). 11,12 Recently, a new surgical treatment has been described: corneal allogeneic intrastromal ring segment or CAIRS, [13][14][15][16] which refers to the use of any form of allogeneic tissuefresh, preserved, processed donor stroma, placed within intrastromal corneal channels.…”

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confidence: 99%

“…5–7 ICRS has been shown to be very effective in all keratoconus stages; however, it is less effective in more advanced cases. 8–10 The advanced keratoconus, on the other hand, requires a more invasive approach, such as deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK). 11,12…”

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Donut-shaped Corneal Allogeneic Intrastromal Segment as an Alternative to Deep Anterior Lamellar Keratoplasty in Advanced Keratoconus

Coscarelli,

Torquetti

2024

Cornea

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Purpose: The aim of this study was to describe a new technique of selective corneal stromal transplantation for keratoconus treatment, donut-shaped CAIRS (corneal allogeneic intrastromal ring segment). Methods: A donut-shaped corneal graft is obtained using a double-bladed trephine. Descemet membrane, endothelium, and epithelium are all removed from the graft. Only stromal tissue is transplanted. A wide 360-degree intrastromal tunnel is created using the femtosecond laser, with a 30-degree angulation. The diameter is from 5.4 mm to 8 mm optical zone. After dehydration, the corneal graft is inserted into the tunnel. We report the clinical and tomographic outcomes after the procedure in 3 patients. Results: The mean follow-up time after donut-shaped CAIRS was 6.01 ± 1.02 months. In case 1, best spectacle–corrected visual acuity improved from 20/150 to 20/40. In case 2, it improved from 20/400 to 20/40, and in case 3 from 20/200 to 20/40. The mean preoperative K was 57.3 ± 4.5 D and reduced to 44.2 ± 2.5 D after donut-shaped CAIRS. The mean spherical equivalent decreased from −9.8 ± 3.2 preoperatively to −3.2 ± 2.2 postoperatively. No intraoperative or postoperative complications were observed. Anterior segment OCT showed a mid-stroma implant, fusiform in shape, equidistant from the epithelium and endothelium. Conclusions: Donut-shaped CAIRS is a variation of the traditional CAIRS technique and showed to be an alternative option for keratoconus treatment, especially in moderate to advanced cases with a central clear cornea without scars. The technique is minimally invasive, and the visual axis remains untouched.

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Visual and Tomographic Outcomes of a 300° Arc-length ICRS Implantation in Moderate to Advanced Central Keratoconus

Cited by 5 publications

References 36 publications

Intrastromal Corneal Ring Segments Implantation After Deep Anterior Lamellar Keratoplasty for Astigmatism Correction: Mid-term and Long-term Follow-up

Intrastromal Corneal Ring Segments Implantation After Deep Anterior Lamellar Keratoplasty for Astigmatism Correction: Mid-term and Long-term Follow-up

A New Pre-descemetic Corneal Ring (Neoring) in Deep Anterior Lamellar Keratoplasty for Moderate-Advanced Keratoconus: A Pilot 2-Year Long-Term Follow-Up Study

Donut-shaped Corneal Allogeneic Intrastromal Segment as an Alternative to Deep Anterior Lamellar Keratoplasty in Advanced Keratoconus

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