Evaluation of a new nomogram for Ferrara ring segment implantation in keratoconus

AIM: To evaluate the short-term clinical outcomes of Ferrara rings in keratoconus using an optimized nomogram developed after several years of research and retrospective analysis of clinical data. METHODS: This prospective longitudinal non-comparative clinical trial evaluated 88 eyes of 88 patients (age 18-62y) with keratoconus diagnosis from two Spanish centers. Ferrara ring segment (AJL Ophthalmic) implantation was performed in all cases, using the mechanical procedure in 25 eyes (28.4%) and a femtosecond laser-assisted procedure in 63 eyes (71.6%). The ring segments implanted in each case were selected using a new optimized nomogram that considered variables such as anterior corneal asphericity and astigmatism or the discrepancy among astigmatism and coma orientations. Visual, refractive, corneal topographic, aberrometric, and pachymetric changes after surgery were evaluated during a 3-month follow-up. RESULTS: The implants induced a significant refractive change as well as an improvement in uncorrected (UDVA) and corrected distance visual acuity (CDVA; P<0.001). Postoperative CDVA of 0.10 logMAR or better was achieved in 28.4% and 46.5% of eyes, respectively. Two eyes (2.3%) lost two or more lines of CDVA whereas a total of 53.5% of eyes gained lines of CDVA. A significant central anterior and posterior corneal flattening was induced (P≤0.003), with a significant reduction of anterior (P<0.001) and posterior corneal astigmatisms (P=0.048), and a change in anterior asphericity (P<0.001). Total primary coma (6 mm pupil) change was also statistically significant (preoperative 3.66±3.04 ?m vs postoperative 2.33±2.26 ?m, P<0.001). No significant differences were found in the effect of ring segments between cases implanted using the mechanical and femtosecond techniques (P≥0.101). CONCLUSION: The implantation of Ferrara rings based on the nomogram evaluated is safe and effective for promoting a visual rehabilitation in keratoconus, with a relevant control of primary coma aberration.Supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal (RYC-2016-20471)

Improving Visual Comfort during Computer Gaming with Preservative-Free Hyaluronic Acid Artificial Tears Added to Ergophthalmological Measures

Digital asthenopia (DA) or Computer Vision Syndrome can occur after prolonged use of digital devices and is usually managed with ergophthalmological measures and the use of artificial tears. This prospective, controlled study evaluated the use of hyaluronic acid artificial tears on the signs and symptoms of DA in participants of a videogame convention. Subjects (n = 56) were randomized into a control group (CG, n = 26), which followed ergophthalmological measures, and a study group (SG, n = 30), which followed ergophthalmological measures and instilled 1 drop of artificial tears with hyaluronic acid 0.15% four times a day. Subjects were evaluated before and after playing for three consecutive days for eye dryness (SPEED questionnaire), conjunctival hyperemia, corneal fluorescein staining, conjunctival lissamine green staining, tear breakup time, Schirmer I test, near convergence and accommodation, and using questionnaires for DA symptoms. After 3 days of intense videogaming, the SPEED score of CG increased significantly (p = 0.0320), while for the SG it was unchanged. Similarly, the CG presented significant increases in ocular fatigue (p = 0.0173) and dryness (p = 0.0463), while these parameters decreased significantly in the SG (p = 0.0149 and p = 0.00427, respectively). This study confirms the protective effect of hyaluronic acid artificial tears against DA symptoms associated with prolonged visual display terminal use.This study was funded by Laboratoires Théa SA.Medicin

Effect of the variability in implantation depth of intracorneal ring segments using the femtosecond laser technology in corneal ectasia

Purpose: To analyze the impact of the depth of implantation of intracorneal ring segments on morphological, biomechanical, and clinical outcomes in ectatic corneas. Methods: This prospective longitudinal study enrolled 40 eyes of 29 patients (age 20–51 years) with corneal ectasia that underwent intracorneal ring segments implantation (KeraRing, Mediphacos). Changes in visual acuity, refraction, corneal tomography, and corneal biomechanics (Ocular Response Analyzer, Reichert) were evaluated during a 6 month follow-up. Likewise, changes in ring segment implantation depth measured by optical coherence tomography (Visante OCT, Carl Zeiss Meditec) were also evaluated. Results: Mean relative depth of implantation was 71.6 ± 5.8%, 71.5 ± 6.5%, and 71.9 ± 6.3% at 1, 3, and 6 months after surgery, respectively (p = 0.827). The difference between the real relative depth of implantation and the theoretical attempted value of 70% was not statistically significant (p = 0.072). Differences in spherical equivalent during the follow-up changed significantly depending on the level of relative depth of implantation (p = 0.036), with an increase of 0.114 D per each 1% increase in relative depth of implantation. Likewise, a decrease of –0.194 D in the steepest keratometric reading was found per each decrease of 1% in relative depth of implantation (p = 0.026). Changes in corneal thickness (p = 0.092) and biomechanics (p = 0.080) were not related to relative depth of implantation. Conclusion: The effect on visual acuity and refraction of intracorneal ring segments when implanted in corneal ectasia is less clinically relevant when the implantation is done at a very deep plane. The variability of the depth of intracorneal ring segments implantation when using femtosecond laser technology is minimal and with no clinically significant effect on clinical outcomes.The author David P Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471

Two-Year Follow-up of Intracorneal Ring Segments Implantation in Adolescent Patients With Keratoconus

PURPOSE:To evaluate the visual, refractive, topographic, and aberrometric outcomes after intracorneal ring segments (ICRS) implantation in adolescent patients with keratoconus. METHODS:A retrospective longitudinal study was undertaken with a total of 61 eyes from 47 patients with keratoconus, aged between 13 and 18 years, implanted with a Ferrara-type ICRS. Topography (flattest keratometry, steepest keratometry, and asphericity), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error (sphere and cylinder), and aberrometric measurements (spherical aberration and vertical coma) were evaluated before surgery and at 1 month, 6 months, 1 year, and 2 years after surgery. RESULTS:UDVA exhibited a statistically significant increase at all times from 1 month to 2 years postoperatively (P < .001), whereas CDVA showed a statistically significant improvement at 1 month, 6 months, and 2 years (P < .002), but dropped in significance at 1 year postoperatively (P = .097). The refractive error analysis showed no variation in statistical significance in the sphere (P = .712) after 2 years. The cylinder presented a statistically significant decrease in diopters at all times from preoperatively to 2 years postoperatively (P < .007). Steepest keratometry manifested a statistically significant decrease in steepness at all times after surgery (P < .001), whereas flattest keratometry lost significance at 1 year (P = .298) and 2 years (P = .053) postoperatively. There was no statistically significant change in the spherical aberration at any of the measured times. The vertical coma was only significantly different at 2 years postoperatively (P = .001). CONCLUSIONS:ICRS implantation is a safe and effective treatment for improving visual and corneal morphological parameters as shown at 2 years of follow-up in adolescent patients with keratoconus. It is a good option to flatten and regularize the cornea and to temporarily improve the quality of life of young patients and delay the need for keratoplasty.Programa Nacional de Cooperación Público-Privada. Subprograma INNPACTO 2015 ECTASIA Project (CP-M).Medicin

Enhanced oxidative stress and other potential biomarkers for retinopathy in type 2 diabetics: beneficial effects of the nutraceutic supplements

We have studied the global risk of retinopathy in a Mediterranean population of type 2 diabetes mellitus (T2DM) patients, according to clinical, biochemical, and lifestyle biomarkers. The effects of the oral supplementation containing antioxidants/omega 3 fatty acids (A/ω3) were also evaluated. Suitable participants were distributed into two main groups: (1) T2DMG (with retinopathy (+DR) or without retinopathy (-DR)) and (2) controls (CG). Participants were randomly assigned (+A/ω3) or not (-A/ω3) to the oral supplementation with a daily pill of Nutrof Omega (R) for 18 months. Data collected including demographics, anthropometrics, characteristics/lifestyle, ophthalmic examination (best corrected visual acuity, ocular fundus photographs, and retinal thickness as assessed by optical coherence tomography), and blood parameters (glucose, glycosylated hemoglobin, triglycerides, malondialdehyde, and total antioxidant capacity) were registered, integrated, and statistically processed by the SPSS 15.0 program. Finally, 208 participants (130 diabetics (68 +DR/62 -DR) and 78 controls) completed the follow-up. Blood analyses confirmed that the T2DMG+DR patients had significantly higher oxidative stress (p < 0.05), inflammatory (p < 0.05), and vascular (p < 0.001) risk markers than the T2DMG-DR and the CG. Furthermore, the A/ω3 oral supplementation positively changed the baseline parameters, presumptively by inducing metabolic activation and ameliorating the ocular health after 18 months of supplementation