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International Journal of Keratoconus and Ectatic Corneal Diseases
Current Issue : Volume 3, Issue 2, May-August 2014
 
 
1.  Editorial
KANELLOPOULOS-KERATOCONUS DIAGNOSIS AND TREATMENT, 2014
A John Kanellopoulos
[Pages No:v-xi]
Full Text PDF | Abstract | FREE

ABSTRACT

KANELLOPOULOS-KERATOCONUS DIAGNOSIS AND TREATMENT, 2014

A Few Thoughts, Unanswered Questions and Hopes in regard to Keratoconus Diagnosis and Treatment

As the corneal collagen cross-linking (CXL) treatment is intended to be applied in eyes developing progressive ectasia, it is of paramount importance the establishment of early and sensitive criteria for the diagnosis of keratoconus as well as the establishment of possible progression.

 
2.  Original Article
Complications of Intrastromal Corneal Ring Implantation (Keraring 355°) using a Femtosecond Laser for Channel Creation
Khosrow Jadidi, Seyed Aliasghar Mosavi, Farhad Nejat, Aliagha Alishiri
[Pages No:53-56]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1079 | FREE

ABSTRACT

Purpose: To report complications after the implantation of Keraring 355° intrastromal corneal ring (ICR; Mediphacos, Belo Horizonte, Brazil) in keratoconic eyes using a Ziemer LDV femtosecond laser (Ziemer AG, Switzerland) for channel creation.

Materials and methods: Five eyes suffering from keratoconus underwent Keraring 355° insertion using Ziemer LDV for corneal pocket creation. Intraoperative and postoperative complications were recorded.

Results: While intraoperatively there were no complication, postoperatively all cases showed severe side effects.

Conclusion: In this small case series, intracorneal ring (Keraring 355°) implantation using a femtosecond laser for channel creation was related to a number of significant postoperative problems in all cases. The most common complication was corneal melting (postoperatively).

Keywords: Femtosecond laser-intrastromal corneal ring, Keraring 355°, Keratoconus-complication.

How to cite this article: Jadidi K, Mosavi SA, Nejat F, Alishiri A. Complications of Intrastromal Corneal Ring Implantation (Keraring 355°) using a Femtosecond Laser for Channel Creation. Int J Kerat Ect Cor Dis 2014;3(2):53-56.

Source of support: Nil

Conflict of interest: None declared

 
3.  Original Article
Biomechanics of the Cornea
Albert Daxer
[Pages No:57-62]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1080 | FREE

ABSTRACT

The purpose of this article is to provide an applicable and easy-to-use mathematical model of the biomechanics of the cornea. The new spherical dome model considers not only the heterogeneity of the tunica of the eye and distinguishes structurally between cornea, limbus and sclera. It also implements the structural anisotropy inside the corneal stroma caused by the corneas lamellar structure as well as the asphericity of the corneal shape.

Keywords: Cornea, Biomechanics, Corneal stress, Corneal model, LASIK, LASEK, PRK, SMILE, Keratectasia, Spherical dome model.

How to cite this article: Daxer A. Biomechanics of the Cornea. Int J Kerat Ect Cor Dis 2014;3(2):57-62.

Source of support: Nil

Conflict of interest: None

 
4.  Original Article
Five Years Follow-up of Riboflavin/Ultraviolet A (370 nm) Corneal Collagen Cross-linking to Halt the Progression of Keratoconus
PS David O’Brart, Parul Patel, Naomi A O’Brart
[Pages No:63-68]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1081 | FREE

ABSTRACT

Aims: To determine the long-term efficacy and safety of riboflavin/ultraviolet a corneal cross-linking (CXL) to halt the progression of keratoconus.

Materials and methods: Thirty-five patients (35 eyes) who had undergone CXL with epithelial removal 5 or more years previously were examined.

Results: At 5 years, mean spherical equivalent (SEQ) increased by 0.78 diopters (D) (p < 0.001), mean simulated K (Sim K) reduced by 0.86D (p < 0.00001), cone apex power (CAP) reduced by 1.1D (p < 0.0002) and root mean square (RMS) (p < 0.0001), coma (p < 0.0001), and secondary astigmatism (p < 0.001) decreased compared to preoperative values. Compared to values at 1 year, mean refractive cylinder reduced by 0.26D (p < 0.05), mean Sim K reduced by 0.46D (p < 0.0005), CAP reduced by 0.81D (p < 0.01), RMS (p < 0.001), coma (p < 0.002) and secondary astigmatism (p < 0.02) reduced and central pachymetry increased (p < 0.05) at 5 years. No treated eyes showed evidence of progression at 5 years. None lost >1 line of CDVA. Eight untreated fellow eyes progressed during the follow-up period and underwent CXL.

Conclusions: Corneal cross-linking is an effective treatment to halt the progression of keratoconus at 5 years, with no sight-threatening complications. Improvements in topographic and wave-front indices present at 1 year continue to improve at 5 years.

Keywords: Keratoconus, Cross-linkage, Riboflavin, Ultraviolet light.

How to cite this article: O’Brart PSD, Patel P, O’Brart NA. Five Years Follow-up of Riboflavin/Ultraviolet A (370 nm) Corneal Collagen Cross-linking to Halt the Progression of Keratoconus. Int J Kerat Ect Cor Dis 2014;3(2):63-68.

Source of support: Nil

Conflict of interest: None

 
5.  Review Article
How to improve Visual Acuity after Intrastromal Corneal Ring Segments? Implantation for Keratoconus and Post-LASIK Ectasia
Adel Barbara, Ramez Barbara
[Pages No:69-75]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1082 | FREE

ABSTRACT

Keratoconus (KC) is an ecstatic corneal disease that causes irregular astigmatism which cannot be corrected by glasses, the irregular astigmatism causes loss of visual acuity (VA) both the uncorrected and the corrected VA, in addition to deterioration in the quality of vision. Contact lenses (CLs) improve the VA but cannot be tolerated in many cases due to several causes, such as loss of motivation, atopic and allergic conjunctivitis that are more frequently associated with KC and dry eyes. Intrastromal corneal ring segments implanted in keratoconic eyes improve uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), reduce myopia, astigmatism, high order aberrations (HOA) and regularizes the cornea (less irregular astigmatism), similar results are achieved in the treatment of post-LASIK and post PRK ectasia. These results were confirmed in long-term follow-up. The more advanced the KC the more is the effect of the ICRS but the less the functional VA achieved and vice versa. Thicker rings are more effective, and the smaller the optical zone the more is the effect of the ICRS. The aim of ICRS implantation in KC is not to be free of glasses or CL but to enable the patient of seeing with glasses or to tolerate CL in order to prevent or delay the need for penetrating keratoplasty (PKP) or deep anterior lamellar keratoplasty (DALK). In many cases, we can achieve a functional and satisfactory UCVA with no need for glasses and this is the case in nonadvanced KC but not in the advanced cases. In some cases, the results achieved need additional means to improve VA in order to get satisfactory VA. There are nonsurgical and surgical means to improve VA after ICRS, these means will be reviewed in this article.

Keywords: Keratoconus, Intrastromal, Cornea, Rings, Intacs, Ferrara rings, Penetrating keratoplasty, Deep lamellar keratoplasty, Collagen, Cross-linking, PRK, Lasik, Ectasia.

How to cite this article: Barbara A, Barbara R. How to improve Visual Acuity after Intrastromal Corneal Ring Segments? Implantation for Keratoconus and Post-LASIK Ectasia. Int J Kerat Ect Cor Dis 2014;3(2):69-75.

Source of support: Nil

Conflict of interest: None declared

 
6.  Review Article
Wavefront Analysis for Keratoconus
Jamyl Habib Castillo, Rana Hanna, Eran Berkowitz, Beatrice Tiosano
[Pages No:76-83]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1083 | FREE

ABSTRACT

Keratoconus is the most common primary corneal ectasia, involving a thinning of the central cornea, leading to irregular corneal astigmatism. Wavefront analysis is an evolving field in the area of corneal surgery, initially designed for laser refractive treatments, but today is growing in importance and application in the diagnosis and treatment of corneal disorders such as keratoconus. In this article we will review the theoretical background of high order aberrations and the wavefront analysis as a tool for the diagnosis of keratoconus.

Keywords: Keratoconus, Wavefront analysis, High order aberrations, Astigmatism, Cornea, Habib zernike polynomials, Vertical coma.

How to cite this article: Castillo JH, Hanna R, Berkowitz E, Tiosano B. Wavefront Analysis for Keratoconus. Int J Kerat Ect Cor Dis 2014;3(2):76-83.

Source of support: Nil

Conflict of interest: None

 
7.  Retrospective Study
Corneal Cross-linking in Patients Younger than 18 Years: Long-term Follow-up in Three Israeli Medical Centers
Erez Bakshi, Irina S Barequet, Isaac Aizenman, Samuel Levinger, Isaac Avni, David Zadok
[Pages No:84-87]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1084 | FREE

ABSTRACT

Purpose: To report refractive, topographic and safety outcomes of corneal cross-linking (CXL) in patients younger than 18 years of age with progressive keratoconus.

Materials and methods: In this retrospective study, we enrolled 31 eyes of 21 children aged 11 to 17 years that underwent corneal riboflavin-ultraviolet A induced CXL due to progressive keratoconus at three different ophthalmology departments in Israel. They were followed for 3 to 48 months (average 23 ± 13.6 months). Evaluated parameters were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction, pachymetry, slit- lamp examination and corneal topography at baseline and at 1,3,6,12,24 and 48 months.

Results: We found a nonsignificant improvement in UCVA and BSCVA with a small reduction of manifest cylinder and no significant change in spherical equivalent or K-values. Following CXL, stability of UCVA and BSCVA at the last follow-up examination was found in 71 and 77% of treated eyes, respectively. No permanent adverse events have been recorded throughout the study period.

Conclusion: In our series, CXL was a safe procedure in the pediatric population. Stabilization of progressive keratoconus was achieved in visual acuity, refractive and topography parameters with no improvement in corneal indices in contrary to adult CXL treatment.

Keywords: Progressive keratoconus, Collagen cross-linking, Riboflavin, UVA irradiation, Pediatric.

How to cite this article: Bakshi E, Barequet IS, Aizenman I, Levinger S, Avni I, Zadok D. Corneal Corss-linking in Patients Younger than 18 Years: Long-term Follow-up in Three Israeli Medical Centers. Int J Kerat Ect Cor Dis 2014;3(2):84-87.

Source of support: Nil

Conflict of interest: None declared

 
8.  Case Series
Intrastromal Corneal Ring Segment with and without Collagen Corneal Crosslinking vs Penetrating Keratoplasty for the Treatment of Keratoconus
Ramez Barbara, Adel Barbara
[Pages No:88-94]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1085 | FREE

ABSTRACT

Keratoconus (KC) is a noninflammatory progressive corneal degeneration that cause irregular astigmatism especially in moderate and advanced cases, the irregular astigmatism can not be corrected by glasses, contact lenses are the only optical way for improving the visual acuity (VA) in these patients. In this retrospective study, we shall present the results of eight patients suffering from KC who were treated by PKP in one eye (PKP group) and ICRS (ICRS group) with or without CXL in the second eye. All the ICRS surgeries, the CXL and the PRK were performed at the I Vision, Refractive Surgery and Keratoconus Treatment Center in Haifa, Israel, by the same surgeon (AB), the PKPs were performed elsewhere, because they were treated in our medical center after the PKP.

Keywords: Keratoconus, Intrastromal, Cornea, Rings, Intacs, Ferrara rings, Penetrating keratoplasty, Deep lamellar keratoplasty, Collagen, Cross-linking.

How to cite this article: Barbara R, Barbara A. Intrastromal Corneal Ring Segment with and without Collagen Corneal Crosslinking vs Penetrating Keratoplasty for the Treatment of Keratoconus. Int J Kerat Ect Cor Dis 2014;3(2):88-94.

Source of support: Nil

Conflict of interest: None declared

 
9.  Case Report
Corneal Thinning after Contact Lens-related Infective Keratitis
Raquel Almeida, Filipa Rodrigues, Matheus Santos, Renata Siqueira, Patrícia Contarini, Jose Salgado-Borges, Renato Ambrosio Jr
[Pages No:95-98]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1086 | FREE

ABSTRACT

Purpose: To describe two cases of contact lens-related infectious keratitis with secondary corneal thinning.

Material and methods: Case reports and review of the literature.

Results: The first case is of a 13-year-old girl, contact lens user, admitted for acute corneal infection in her right eye (OD). Seven years after treatment, she presented with corneal thinning and flattening with uncorrected distance visual acuity of 20/30 OD; thinnest value was 363 µm in OD and 513 µm in the left eye (OS). The second case is a 22-year-old male, cosmetic contact lens user, first presented with severe keratitis in OD. One year after treatment, the eye was quiet with moderate corneal opacity; corneal thickness was 228 µm OD and 561 µm OS. Ectasia was identified due to the protrusion and steepening with an irregular curvature pattern. Rigid gas permeable (RGP) contact lens fitting enabled visual acuity of 20/25 OD.

Conclusion: Corneal melt with secondary stromal loss and thinning may lead or not to secondary ectasia. Visual rehabilitation is possible with RGP contact lenses despite corneal opacity. The risk of infectious keratitis among contact lenses users should be considered.

Keywords: Corneal ulcers, Ectasia, Contact lenses.

How to cite this article: Almeida R, Rodrigues F, Santos M, Siqueira R, Contarini P, Salgado-Borges J, Ambrosio R Jr. Corneal Thinning after Contact Lens-related Infective Keratitis. Int J Kerat Ect Cor Dis 2014;3(2):95-98.

Source of support: Nil

Conflict of interest: None declared

 
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