Abstract
We evaluate the efficacy and safety of Keraring 355° intrastromal corneal ring segment (ICRS) implantation aided by PocketMaker microkeratome for the correction of keratoconus. Patients underwent ICRS insertion using mechanical dissection with PocketMaker microkeratome and completed 6 months of follow-up. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, safety, efficacy index, and adverse events were reported for six months postoperatively. We evaluated 15 eyes of 15 patients (12 men) with a mean age of 28.87 ± 6.94 years (range 21–49 years). At final postoperative examination, there was a statistically significant reduction in the spherical equivalent refractive error compared to preoperative measurements (−5.46 ± 1.52 to −2.01 ± 1.63 D, P < 0.001). Mean preoperative UCVA (logMAR) before implantation was 0.79 ± 0.48, and postoperative UCVA was 0.28 ± 0.15, P = 0.001. Mean preoperative BSCVA (logMAR) before implantation was 0.36 ± 0.21; at final follow-up examination BSCVA was 0.18 ± 0.9, P = 0.009. Mean K decreased from 48.33 to 43.31 D, P < 0.001. All patients were satisfied with ICRS implantation; 86.7% were moderately to very happy with the results. No intraoperative or postoperative complications were demonstrated. This preliminary study shows that ICRS (Keraring 355°) implantation is an efficient, cost-effective, and minimally invasive procedure for improving visual acuity in nipple type keratoconic corneas.
Highlights
Keratoconus is a bilateral, progressive, noninflammatory disease of the cornea which often leads to high myopia and astigmatism with an estimated prevalence of approximately 1 in 2000 [1]
The mean best spectacle-corrected visual acuity (BSCVA) improved to 0.18 ± 0.9 logMAR (P = 0.009) at six months after implantation (Figure 2)
There was a significant improvement in spherical equivalent refractive error from −5.46±1.52 diopters (D) preoperatively to −2.01± 1.63 (P < 0.001) at 6 months postoperatively (Table 3)
Summary
Keratoconus is a bilateral, progressive, noninflammatory disease of the cornea which often leads to high myopia and astigmatism with an estimated prevalence of approximately 1 in 2000 [1]. The incidence of keratoconus is estimated to be between 50 and 230 per 100,000 [2–4]. It seems to be a multifactorial disease with an unknown exact etiology which impairs the quantity and quality of vision secondary to thinning in and protrusion of the cornea. This results in an irregular astigmatism with or without myopia [5–7]. In more advanced stages with severe corneal irregular astigmatism and stromal opacities, surgical treatment with deep lamellar keratoplasty and penetrating keratoplasty (PK) should be considered [9–13]
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