Visual outcomes in advanced keratoconus using different strategies: Scleral lens, intracorneal ring segment and lamellar keratoplasty

Abstract

Purpose: To compare VA outcomes in patients with advanced keratoconus wearing SCL or after ICRS or DALK. In addition, determine the percentage of complimentary treatments after ICRS and DALK, and which of these was fitting a SCL, and final visual acuity (f-VA) results. Methods: Retrospective case series analyzed 55 eyes with advanced keratoconus fitted with SCL, or after ICRS or a DALK between 2010 and 2018. The variables analyzed were sex, age, UDVA, CDVA, SEQ, K-readings, and f-VA after complimentary treatments. Results: Twenty-eight eyes underwent a DALK, 14 were fitted with a SCL, and other 13 underwent ICRS insertion. Patients after DALK and after ICRS showed statistically significant improvement in UDVA and CDVA after surgery, with no difference between these groups. Patients fitted with SCL showed statistically higher CDVA improvement when compared to ICRS. After DALK and ICRS, respectively, nine eyes (32.14%) and seven eyes (53.85%) were fitted with SCL. Comparison between f-VA with SCL in three groups showed that the best result was achieved in DALK + SCL, with statistically significant difference to only SCL. Conclusion: We showed that the CDVA of eyes fitted with SCL without any surgical treatment was statistically better than CDVA of eyes after ICRS insertion. After DALK and ICRS insertion, many patients needed a complimentary treatment to improve CDVA. The most chosen treatment was fitting a SCL. After this, all eyes showed statistically significant improvement in f-VA, with statistically better results for DALK + SCL when compared to SCL fitted in advanced keratoconus without any surgical treatment.

Results of intrastromal corneal ring implantation in advanced keratoconus With the aim of postpoing or avoiding corneal transplantation

“…On the other hand, no complication was observed in the group that had the ring implant. 26 Only one case of complication was observed in this study; 70% of patients achieved corrected distance visual acuity better than or equal to 20/40 (0.3 logMAR), and 80% of patients achieved visual acuity better than or equal to 20/25 (0.1 logMAR) with the use of scleral contact lenses, reporting comfort with use.…”

Outcomes of 320-degree intrastromal corneal ring segment implantation for advanced keratoconus

“…Only few investigators compared ICRS implantation to corneal transplantation for advanced keratoconus with variable results. [ 17 18 19 ] Our findings suggest 320-ICRS is a promising therapeutic option in ACEs, avoiding corneal graft and its inherent risks of rejection and other significant complications, which is especially unneglectable for this relatively young population. Besides, the BCVA in our study was corrected with spectacles.…”

Descemetic Deep Anterior Lamellar Keratoplasty versus Penetrating Keratoplasty in Advanced Keratoconus: Comparison of Visual and Refractive Outcomes

“…Our finding was consistent with the results of several other studies on the results of PK or DALK in advanced keratoconus. 4,[17][18][19][20][21][22][23][24][25] There is substantial literature evidence that both DALK and PK lead to equivalent CDVA and refractive outcomes in patients with keratoconus 12 months postoperatively. In contrast, Shi et al reported that PK resulted in a more significant improvement in CDVA, with no discernible differences in refractive outcomes, but a higher incidence of rejection when compared to DALK.…”