Abstract
Background Intrastromal corneal ring segments are widely adopted for keratoconus management. However, the complete ring (Myoring) was proposed to be superior in advanced cases. Myoring can be implanted either via femtoassisted or manual dissection techniques. A comparison between both techniques can delineate any differences in the outcomes. Methods This was a prospective interventional case series study. Sixty-four eyes with progressive advanced keratoconus were enrolled: 36 and 28 had femtoassisted or manual Myoring, respectively. Uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), maximal keratometry (Kmax), spherical equivalent (SE) and corneal thinnest location were measured in all eyes preoperatively and at one, six, and 12 months postoperatively. Epi-off corneal cross-linking (CXL) was performed eight weeks after Myoring implantation for all cases. Results Femtoassisted Myoring dissection significantly improved UCVA and CDVA from 0.1 ± 0.06 and 0.18 ± 0.1 preoperatively to 0.29 ± 0.08 and 0.43 ± 0.1 at 12 months. Also, manual technique similarly enhanced UCVA and CDVA from 0.11 ± 0.05 and 0.2 ± 0.1 preoperatively to 0.27 ± 0.2 and 0.4 ± 0.2 at 12 months. In terms of safety, while no cases of ring extrusion were encountered with the femtoassisted technique, six (21.4%) cases of extrusion were encountered in the manual group. Conclusion Femtoassisted or manual Myoring technique followed by CXL is an effective choice for advanced progressive keratoconus. Although it did not reach a statistical significance, the high extrusion rate with manual dissection is a red flag to be considered.
Highlights
Intrastromal corneal ring segments are widely adopted for keratoconus management
Correction [4] through flattening the central cornea via an “arc-shortening” effect on the corneal lamellae [5]. e concept of a full corneal intrastromal ring as an additive refractive technique for the correction of myopia was first proposed by Reynolds in 1978 [6]
We aimed to evaluate the effectiveness and safety of the Myoring (Dioptex, GmbH, Linz, Austria) followed by corneal cross-linking (CXL) in advanced KC
Summary
Intrastromal corneal ring segments are widely adopted for keratoconus management. Myoring can be implanted either via femtoassisted or manual dissection techniques. Sixty-four eyes with progressive advanced keratoconus were enrolled: 36 and 28 had femtoassisted or manual Myoring, respectively. Femtoassisted Myoring dissection significantly improved UCVA and CDVA from 0.1 ± 0.06 and 0.18 ± 0.1 preoperatively to 0.29 ± 0.08 and 0.43 ± 0.1 at 12 months. Femtoassisted or manual Myoring technique followed by CXL is an effective choice for advanced progressive keratoconus. It did not reach a statistical significance, the high extrusion rate with manual dissection is a red flag to be considered. Enhanced by Daxer [7], implantation of a full corneal intrastromal implantation system (CISIS) has been considered for KC management [8,9,10].
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