Faria-Correia, F

Franqueira, N

Leite, R

Mendes, J

Monteiro, T

Sousa, K

Vaz, F

English

Institutional repository of Hospital de Braga

CORNEAL	  SEGMENT	  RINGS	  BASED	  ON	  NEW	  NOMOGRAMS	  FOR	  KERATOCONUS:	  SURGICAL	  TECHNIQUE	  Keissy	  Sousa,	  Tiago	  Monteiro,	  Nuno	  Franqueira,	  Fernando	  Faria-­‐Correia,	  Ricardo	  Leite,	  José	  Mendes,	  Fernando	  Vaz	  Hospital	  de	  Braga,	  Portugal	  RESULTS	  INTRODUCTION	  	  The	   surgical	   treatment	   ok	   keratoconus	   has	   become	   a	   refracIve	  procedure.	   Past	   surgical	   opIons	   and	   previous	   intracorneal	   rings	  implantaIon	   nomograms	   were	   “blind”	   treatments	   based	   on	   axial	  topography	   and	   anterior	   curvature.	   The	   results	   were	   measured	  simply	   in	   terms	   of	   corneal	   flaQening,	   following	   the	   “rules”	   of	  Barraquer.	   The	   past	   years	   have	   brought	   the	   concept	   of	   quality	   of	  vision	  and	  aberrometry.	  	  	  The	   new	   nomograms	   for	   intracorneal	   segments	   are	   based	   on	  subjecDve	  refracDon,	   the	  axial	  curvature,	   the	  aberrometry	   (coma),	  corneal	  asphericity	  and	  the	  locaDon	  of	  the	  thinnest	  point	  –	  it	  is	  the	  ectasia	  phenotype	  classifica/on	  era.	  	  We	  can	  combine	  different	  arc	   lengths	  and	  thickness	  to	  provide	  the	  best	  approach	  depending	  on	  the	  ectasia	  phenotype.	  	  MATHERIAL	  AND	  METHODS	  Our	   objecDve	   is	   to	   present	   our	   surgical	   technique	   for	   intracorneal	  ring	   segments	   (ICRS)	   explanaIon	   and	   exchange	   for	   Ferrara®	   type	  segments;	   offering	   to	   paIents	   previously	   treated	   in	   the	   past	   years	  with	   unimproved	   visual	   acuity	   the	   opportunity	   to	   improve	  uncorrected	  (UCVA)	  and	  corrected	  visual	  acuity	  (BCVA).	  	  -­‐  AnalyIc,	   non-­‐randomized,	   non-­‐comparaIve,	   cohort	   and	  retrospecIve	  study.	  -­‐  Included	   eyes:	   keratoconus	   eyes	   previusly	   treated	  with	   INTACS®	  ICRS;	   previous	   follow-­‐up	   of	   12	   months	   or	   more	   a`er	   the	   first	  surgery,	  no	  gain	  of	  BCVA	  a`er	  the	  first	  surgery	  and	  no	  progression	  of	  the	  ectasia.	  	  -­‐  All	   eyes	   were	   submiTed	   to	   Ferrara®	   ring	   segment	   implantaIon	  6,00	  mm	  opIcal	  zone	  using	   the	  previous	  corneal	   tunnels	  created	  for	  the	  Intacs	  SK®	  (6,00	  mm	  opIcal	  zone).	  	  -­‐  Main	   Outcome:	   3	   months	   of	   follow-­‐up;	   pre	   and	   post-­‐surgical	  UCVA	  and	  BCVA,	  keratometry	  and	  aberrometry	  parameters.	  CONCLUSION	  	  -­‐  The	   new	   nomograms	   for	   ICRS	   are	   more	   adequate	   to	  improvement	  of	  keratoconus	  stabilizaIon	  and	  refracIve	  results.	  -­‐  Different	   arc	   lenghts	   and	   Ickness	   combinaIon	   of	   Ferrara	   rings	  lead	   to	   	   a	   beQer	   combinaIon	   based	   on	   more	   topographic	  parameters.	  REFERENCES:	   	  1.	  Kanski	  JJ	  BB.	  Clinical	  Ophthalmology	  -­‐	  A	  SystemaIc	  Approach:	  Elsevier	  Saunders;	  2011.	  2.	  Dingle	  T,	  Pepose	  J,	  Qazi	  M,	  Yoon	  G.	  Studies	  of	  Wavefront	  Aberrometry	  in	  Cornea	  Ectasia:	  SLACK	  Incorporated;	  2009.	  3.	  Alfonso	  JF,	  Lisa	  C,	  Merayo-­‐Lloves	  J,	  Fernandez-­‐Vega	  L,	  Montés-­‐Micó	  R.	  Intrastromal	  corneal	  ring	  segment	  implantaIon	  in	  paracentral	  keratoconus	  with	  coincident	  topographic	  and	  coma	   axis.	   J	   Cataract	   and	   Refract	   Sur.	   2012;38:1576-­‐82.	   4.	   Alfonso	   JF,	   Fernandez-­‐Vega	   L,	   Baamonde	   B,	  Merayo-­‐Lloves	   J,	  Montés-­‐Micó	   R.	   Inferior	   Intrastromal	   Corneal	   Ring	   Segments	   in	   Paracentral	  Keratoconus	  with	  no	  coincident	  Topographic	  and	  Coma	  Axis.	  Journal	  of	  RefracIve	  Surgery.	  2013;29(4):266-­‐72.	  0	  0,1	  0,2	  0,3	  0,4	  0,5	  0,6	  1	   2	   3	   4	   5	  Pre	  and	  Post-­‐surgical	  Spherical	  Aberrometry	  Pre	  SPH	  Aberr	  (micra)	  Post	  SPH	  Aberrom	  (micra)	  0	  10	  20	  30	  40	  50	  60	  70	  1	   2	   3	   4	   5	  Pre	  and	  Post-­‐surgical	  Kmax	  (D)	  Pre	  Kmax	  (D)	   Post	  Kmax	  (D)	  0	  0,1	  0,2	  0,3	  0,4	  0,5	  0,6	  0,7	  0,8	  0,9	  1	  Pre	  UCVA	   Pre	  BCVA	   Post	  UCVA	   Post	  BCVA	  Pre	  and	  Post-­‐surgical	  Visual	  AcuiDes	  per	  paDent	  

Corneal Segment Rings Based on New Nomograms for Keratoconus: Surgical Technique

http://repositorio.hospitaldebraga.pt/bitstream/10400.23/823/1/poster%20ICRS%20exchange.pdf

Corneal Segment Rings Based on New Nomograms for Keratoconus: Surgical Technique

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