Abstract
PurposeTo estimate the effectiveness of complete corneal ring (MyoRing) implantation compared with MyoRing implantation combined with corneal collagen crosslinking (CXL) for keratoconus treatment for 36 months follow-up.DesignRetrospective cohort study.Materials and methodsMyoRing implantation was performed in a series of 78 patients (80 eyes) with keratoconus II–III Amsler classification, of these 39 eyes had MyoRing implantation combined with CXL. Implantation of a MyoRing in the corneal pocket was performed using a PocketMaker microkeratome and corneal intrastromal implantation system. During CXL, riboflavin solution 0.1% was injected into the corneal pocket through the incision tunnel and standard surface UVA irradiation (370 nm, 3 mW/cm2) was then applied from 5-cm distance for 30 min.ResultsSignificant improvements in uncorrected distance visual acuity and corrected distance visual acuity were observed for both groups, which was relatively better 12 months after procedure in MyoRing alone group; however, in 36 months there was no difference between groups. Keratometry was reduced in both groups; after MyoRing implantation for 8.45 D and MyoRing + CXL for 9.43 D, the spherical equivalent decreased from 8.45 to 7.72 D and from 9.43 to 6.25 D, respectively. The cylinder decreased to 3.33 D with MyoRing alone and to 3.31 D with MyoRing + CXL. Corneal thickness remained nearly unchanged (from 433.69 ± 38.76 to 434.21 ± 34.98) in MyoRing group and decreased from baseline (from 426.93 ± 46.58 to 401.24 ± 39.12 µm) in MyoRing + CXL group 36 months postoperatively, which corresponds with pachymetry reduction after conventional CXL.ConclusionBoth MyoRing implantation and MyoRing combined with CXL were effective for treating keratoconus. At 36 months, there were slightly better outcomes in MyoRing + CXL group; however, in MyoRing alone group visual and refractive outcomes were stable overtime.
Highlights
Keratoconus is a noninflammatory corneal disease characterized by progressive thinning of the cornea that is accompanied by ectasia [1]
The aim of this study was to estimate the effectiveness of complete corneal ring (MyoRing) implantation alone compared with MyoRing implantation combined with corneal collagen crosslinking (CXL) for keratoconus treatment with 36 months of follow-up
Group 1 with MyoRing implantation alone included 41 eyes, group 2 included 39 eyes that had MyoRing combined with CXL
Summary
Keratoconus is a noninflammatory corneal disease characterized by progressive thinning of the cornea that is accompanied by ectasia [1]. Changing the volume of to the peripheral cornea by ring segment implantation is reported to be useful for improving visual acuity and reducing the corneal steepening associated with keratoconus [2]. Different types of corneal segments may be used for keratoconus treatment, such as Intacs (Addition Technology, Inc.), Ferrara ring (Ferrara Ophthalmics Ltd.), and Keraring (Mediphacos Ltd.). Corneal collagen crosslinking (CXL), introduced by Wollensak et al [6], has become a standard treatment for progressive keratoconus [6,7,8,9] to slow or possibly stop the progression of a disease. The standard technique involves epithelial removal to enable appropriate penetration of riboflavin into the stromal tissue where highly reactive oxygen species trigger formation of crosslinks that consist of intrafibrillary and interfibrillary covalent bonds [6]
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