Intracorneal Ring Segments Implantation Outcomes Using Two Different Manufacturers' Nomograms for Keratoconus Surgery.

Abstract

To compare the outcomes of intracorneal ring segments (ICRS) implantation in keratoconic eyes with a similar tomographic pattern, using two different manufacturers' nomograms for surgical planning. ICRS were implanted alternately in patients with the same tomographic pattern of keratoconus divided into two groups according to the surgical planning proposed by the ICRS manufacturers (Keraring, Mediphacos, Belo Horizonte, Brazil, and Ferrara Ring, AJL Ophthalmics, Vitoria, Spain). Visual, refractive, keratometric, corneal aberrometry, and optical quality changes were evaluated during a 6-month follow-up. Corneal and manifest refractive astigmatic changes were also analyzed using the double-angle polar plot and the Alpins vectorial method through the following components: target induced astigmatism, surgically induced astigmatism, difference vector, correction index, angle of error, index of success, flattening effect, and torque. After ICRS implantation, both groups showed significant improvement (P < .05) in visual and keratometric data. Corneal aberrometric changes and optical quality improvement were also statistically significant in both groups, except for trefoil (P > .05 in all intervals). The Alpins method analysis showed a better performance in the Keraring group, but with no statistically significant difference between groups (P > .05). Comparison between groups showed a statistically significant difference only in tomographic astigmatism in double-angle polar plot analysis (P = .03), with more significant improvement in the Keraring group. Both manufacturers' nomograms resulted in statistically significant improvement in most of the parameters analyzed, with greater correction of corneal tomographic astigmatism in the group operated on according to the spherical equivalent/tomographic astigmatism nomogram. [J Refract Surg. 2019;35(10):673-683.].