Keratoconus treatment using femtosecond-assisted intrastromal corneal graft (FAISCG) surgery: a case series.
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ABSTRACT:
SUBMITTER: Jadidi K
PROVIDER: S-EPMC5790099 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Purpose:To evaluate the outcomes of femtosecond laser-assisted implantation of a 355-degree intracorneal ring (ICR) (Keraring) in patients with keratoconus in the three-year follow-up. Setting:Future Femtolaser Center, Sohag, Egypt. Design:Prospective interventional case series. Patients and Methods:A prospective case series of 38 eyes of 26 patients with keratoconus had implantation of the 355-degree ICR keraring after tunnel creation with a femtosecond laser. The uncorrected visual acuities (UCVA) and best-corrected visual acuities (BCVA), sphere, cylinder, and manifest refraction spherical equivalent (SE), and mean keratometry (K), K max, and K min were evaluated preoperatively and 3, 6, 12, 24, and 36 months postoperatively, and all complications were reported. Results:38 eyes of 26 patients with mean age 25.92?±?5.44 years were enrolled in the study, 11 were males (42.3%). The mean UCVA improved from 0.93?±?0.21 to 0.63?±?0.21 logMAR (P ? 0.001) and the mean BCVA from 0.67?±?0.22 to 0.43?±?0.26 logMAR (P < 0.001). The mean sphere, cylinder, and spherical equivalent have been changed dramatically from preoperative to 3 month postoperative, which is statistically significant (P ? 0.001), and the changes between 1 and 2 years and 2 and 3 years are also considerable and statistically significant; the K max and K min and K mean improved and the changes were statistically significant (P ? 0.001), and the changes between one, two, and three years were also statistically significant. The safety and efficacy indices were changed through the three-year follow-up. The complications were corneal neovascularization (36.84%), corneal melting (26.3%), and ring extrusion (31.5%) at the end of the study. Conclusions:Implantation of a 355-degree intracorneal keraring using femtosecond laser improved the visual, refractive, and topographic parameters in keratoconus patients, with a high rate of ICR extrusion and instability. The study has been registered for the Pan African Clinical Trial Registry (http://www.pactr.org) database within No: PACTR201810796878908 on 29 October 2018.
| S-EPMC6803737 | biostudies-literature
Project description:In this case report, we describe the surgical procedure of corneal inlay preparation and corneal pocket creation using a femtosecond laser system.A 7-year-old girl who presented with unilateral paracentral corneal thinning underwent the surgical procedure of corneal inlay. Preoperatively, the refraction was +10.00-6.00 × 170. One month after the procedure, astigmatism and hyperopia were decreased and the refraction was +5.00-1.25 × 110.Femtosecond laser-assisted pocket creation for the implantation of corneal inlays offers accuracy of pocket parameters, enhancing predictability, resulting in better final outcomes, and improving the safety of the procedure.
| S-EPMC5525504 | biostudies-other
Project description:PurposeTo provide a biomechanical framework to better understand the postsurgical optomechanical behavior of the cornea after ring implantation.MethodsCalibrated in silico models were used to determine the corneal shape and stresses after ring implantation. After mechanical simulations, geometric ray-tracing was used to determine the change in spherical equivalent. The effect of the surgical procedure, circadian variation of intraocular pressure, or the biomechanical weakening introduced by keratoconus (KC) were evaluated for each intrastromal ring.ResultsModels predicted the postsurgical optomechanical response of the cornea at a population level. The localized mechanical effect of the additional intrastromal volume introduced by the implants (size and diameter) drives the postsurgical corneal response. However, central corneal stresses did not increase more than 50%, and thus implants did not strengthen the cornea globally. Because of the biomechanical weakening introduced by laser pocketing, continuous implants in a pocket resulted in higher refractive corrections and in the relaxation of the anterior stroma, which could slow down KC progression. Implants can move within the stroma, acting as a dynamic pivot point that modifies corneal kinematics and flattens the corneal center. Changes in stromal mechanical properties did not impact on refraction for normal or pathological corneas.ConclusionsImplants do not stiffen the cornea but create a local bulkening effect that regularizes the corneal shape by modifying corneal kinematics without canceling corneal motion.Translational relevanceIn silico models can help to understand corneal biomechanics, to plan patient-specific interventions, or to create biomechanically driven nomograms.
| S-EPMC7585389 | biostudies-literature
Project description:Purpose:To evaluate a new tangential map-based nomogram versus the axial map-based nomogram for ICRS in keratoconus. Methods:A prospective case series study including 64 eyes of 64 patients who underwent ICRS implantation. Cone location was determined for each eye with two maps: the axial and the tangential. Appropriate ring selection was determined using two surgical nomograms: axial map-based and tangential map-based. Visual, refractive, and topographic outcomes were assessed before, as well as at 3, 6, and 12 months after ICRS implantation. Results:The cone location, and consequently the ring selection, was significantly different in the two nomograms with a "centralization tendency" in the tangential map. In the axial group, UDVA and CDVA improved from 0.12?±?0.04 and 0.24?±?0.08 to 0.28?±?0.08 and 0.4?±?0.1, respectively. Similarly, MRSE substantially decreased from -6.7?±?3.3 to -1.2?±?1.1D at 12 months after the procedure. In the tangential group, UDVA and CDVA improved from 0.09?±?0.06 and 0.2?±?0.1 to 0.5?±?0.2 and 0.7?±?0.2, respectively. MRSE substantially decreased from -4.9?±?1D at 12 months after the procedure. In the tangential group, UDVA and CDVA improved from 0.09?±?0.06 and 0.2?±?0.1 to 0.5?±?0.2 and 0.7?±?0.2, respectively. MRSE substantially decreased from -4.9?±?1D at 12 months after the procedure. In the tangential group, UDVA and CDVA improved from 0.09?±?0.06 and 0.2?±?0.1 to 0.5?±?0.2 and 0.7?±?0.2, respectively. MRSE substantially decreased from -4.9?±?1P=0.01 ? . Similarly, the gain in the CDVA was 0.4 and 0.15 in the tangential and axial groups, respectively, at 12 months, P=0.01 ? . Similarly, the gain in the CDVA was 0.4 and 0.15 in the tangential and axial groups, respectively, at 12 months. Conclusion:The tangential map-based nomogram attained better visual and refractive outcomes at 1 year. In addition, the cone location was significantly different between both maps with a centralization tendency in the tangential one.
| S-EPMC7049859 | biostudies-literature
Project description:PURPOSE:To assess the long-term outcomes of implanting intrastromal corneal ring segments (ICRS) in paracentral keratoconic eyes. METHODS:58 eyes with paracentral keratoconus with coincident refractive, keratometric, and comatic axes were evaluated. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity and refractive errors were recorded before and at all follow-up visits. The postoperative follow-up was 5 years. Patients were divided into two groups: group I (30 years old or younger) and group II (more than 30 years old). RESULTS:The mean UDVA (logMAR) rose from a preoperative 0.83?±?0.31 to a five-year postoperative 0.42?±?0.33 (P < 0.0001). The mean CDVA varied from 0.16?±?0.17 to 0.11?±?0.18 (P = 0.0003). Both the UDVA and CDVA were stable over the postoperative period in both groups (P > 0.05). The spherical equivalent and the refractive cylinder declined steeply after ICRS implantation in both groups (P < 0.001), and were stable over the postoperative period (P > 0.05). The keratometric values were also stable over the postoperative follow-up. CONCLUSION:Ferrara-type ICRS implantation in keratoconus that meets the characteristics of the sample under study reduces the refractive error at the same time as it improves postoperative UDVA and CDVA six months after surgery and that these results remain stable over five years of follow-up.
| S-EPMC5602624 | biostudies-literature
Project description:PURPOSE:To evaluate the feasibility and efficacy of small-incision femtosecond laser-assisted intracorneal concave lenticule implantation (SFII) and penetrating keratoplasty (PKP) in patients with progressive keratoconus. METHODS:All the patients were clinically diagnosed with progressive keratoconus. Twenty patients underwent PKP (PKP group), and 11 patients underwent SFII (SFII group). Visual acuity, intraocular pressure, corneal topography, corneal visualization Scheimpflug technology, anterior segment optical coherence tomography, and in vivo confocal microscopy were analyzed. RESULTS:Vision improved at 3 months postoperatively in the SFII group. In the PKP group, corrected distance visual acuity improved 1 week after surgery. Corneal topography showed a statistically significant decrease in the anterior K1 and K2. Corneal visualization Scheimpflug technology showed that changes in the biomechanical parameters of the SFII group were also statistically different from those of the PKP group. All the grafts from both groups were clearly visible by anterior segment optical coherence tomography observation. The central corneal thickness of both groups was stable during the 24-month study period. In vivo confocal microscopy showed a few dendritic cells in the subepithelial region in the SFII group. At 3 months after surgery, many dendritic cells and inflammatory cells were observed in the basal epithelium and stroma in the PKP group. CONCLUSIONS:Both SFII and PKP surgical procedures resulted in a stable corneal volume and improved visual acuity in this long-term study. SFII was less invasive and more efficient compared with PKP.
| S-EPMC6407908 | biostudies-literature
Project description:PurposeTo present the surgical value of femtosecond laser capsulotomy in the treatment of capsular contraction.ObservationsThe clinical case of a 63-year-old male patient with single eye who, two months after cataract surgery without complications, presented a significant dislocation of the secondary intraocular lens due to a capsule contraction and epithelial metaplasia that covered the lens optics and caused low vision.ConclusionsThe femtosecond laser-assisted capsulotomy proved to be effective and safe with minimal traction on the zonule and no IOL damage, in this patient with a follow-up of 29 months.
| S-EPMC7472803 | biostudies-literature
Project description:The aim of the present study was to evaluate the effects of femtosecond laser-assisted cataract surgery (FLACS) and phacoemulsification on corneal biomechanics using corneal visualization Scheimpflug technology. The medical records of 50 eyes from 50 patients who received phacoemulsification and intraocular lens implantation because of age-related factors between June 2014 and September 2014 were retrospectively analyzed. FLACS was used in 12 eyes (FLACS group), and conventional phacoemulsification in 38 eyes (PHACO group). The evaluation of corneal biomechanical parameters included the first/second applanation time (A-time1/A-time2), the first/second applanation length (A-length1/A-length2), corneal velocity during the first/second applanation moment (Vin/Vout), highest concavity time, highest concavity-radius (HC-radius), peak distance (PD), deformation amplitude (DA), central corneal thickness (CCT), and intraocular pressure (IOP). The differences in A-length1/A-length2, IOP, CCT, PD, and DA were significant in the PHACO group between those before, 1 week after, and 1 month after surgery. No significant differences in corneal biomechanical parameters were found between those at 1 month after surgery and before surgery. There were significant differences in IOP and CCT in the FLACS group between those before, 1 week after, and 1 month after surgery. There were no significant differences in the other corneal biomechanical parameters. No significant differences were found in corneal biomechanical parameters between those 1 month after surgery and before surgery. There were significant differences in A-length1/A-length2, CCT, PD, and DA between the two groups at 1 week after surgery. There were no significant differences in corneal biomechanical parameters between the two groups at 1 month after surgery. In conclusion, the effect of FLACS on corneal biomechanics is smaller than that of phacoemulsification. The corneal biomechanical parameters are restored to preoperative levels with the healing of the incision, and the reduction of swelling of the tissue near the incision.
| S-EPMC5526192 | biostudies-other
Project description:BackgroundTo examine the cosmetic outcome of femtosecond laser-assisted pterygium surgery (FLAPS) with conjunctival autograft (CAG) and its potential predictive factors.MethodsThis was a prospective interventional case series (NCT02866968). We included 29 patients (29 eyes) with primary pterygium who underwent FLAPS. Cosmetic outcome was graded by two graders (an ophthalmology resident and an experienced ophthalmologist) using Hirst classification system (1-4?=?excellent-poor). Weighted Cohen's kappa analysis was performed to examine the intra- and inter-rater reliability. The relationship between cosmetic outcome and various factors were determined by Spearman's correlation coefficients (r).ResultsThe preoperative severity of pterygium (Tan grading system) was mild/atrophic (7%), moderate/intermediate (62%), and severe/fleshy (31%). An ultrathin CAG (mean thickness of 74.5?±?9.8??m) was fashioned intraoperatively. An excellent cosmetic outcome of FLAPS (median?±?IQR) was observed at 3?months (1.0?±?1.0) and remained similar at 6?months (1.0?±?0.0) and 12?months (1.0?±?0.0) postoperatively. At final follow-up, 27 (93%) patients achieved good-to-excellent cosmetic outcome, with 1 (3%) patient having a poor outcome due to incomplete pterygium removal. Weighted kappa analysis of Hirst grading system showed excellent intra-rater (? =?0.86-0.95) and inter-rater reliability (? =?0.84-0.88). There was a weak and borderline significant correlation between good cosmetic outcome and reduced postoperative CAG thickness (r =?0.38, P =?0.06) but not with age, gender, preoperative pterygium severity, or intraoperative CAG thickness.ConclusionsFLAPS can result in an excellent cosmetic outcome, which may be attributed to the beneficial effect of an ultrathin CAG.Trial registrationClinicalTrials.gov , NCT02866968 . Registered in July 2016.
| S-EPMC7936441 | biostudies-literature
Project description:PurposeTo present the case of a 72-year-old female with epithelial downgrowth after femtosecond laser-assisted cataract surgery.ObservationsThe patient previously underwent YAG vitreolysis after uncomplicated femtosecond laser-assisted cataract surgery and presented 1 year later with epithelial downgrowth causing complete pupillary block and severe angle closure glaucoma. Subsequent management with nd:YAG peripheral iridotomies failed rapidly leading to a confusing presentation with a flat anterior chamber and high intraocular pressure ultimately requiring surgical management.ConclusionsWe describe the occurrence of epithelial downgrowth after femtosecond laser-assisted cataract surgery and illustrate the utility of ultrasound biomicroscopy to differentiate between severe pupillary block and malignant glaucoma.
| S-EPMC6616539 | biostudies-literature