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International Journal of Keratoconus and Ectatic Corneal Diseases
Current Issue : Volume 4, Issue 2, May-August 2015
 
 
1.  EDITORIAL
Progressive Keratoconus: How Tracking them for Treating them Earlier
David Smadja
[Pages No:iv-v]
Full Text PDF | Abstract | FREE

ABSTRACT

Progressive Keratoconus: How Tracking them for Treating them Earlier
As reported in the current issue by Raiskup et al corneal cross-linking procedure has been shown through multiples studies to be effective in halting the progression of ectatic disease. Interestingly, to date, there is still no consensus on the most relevant way to monitor the disease progression in order to track down the first sign of corneal weakening.

 
2.  ORIGINAL ARTICLE
Errors Associated to Keratoconus Grading using Systems based on Corneal Power
David P Piñero Llorens, Vicente Camps, Esteban Caravaca-Arens
[Pages No:41-46]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1096 | FREE

ABSTRACT

Purpose: To analyze and define the possible errors that may be introduced in keratoconus classification when the keratometric corneal power is used in such classification.

Materials and methods: Retrospective study including a total of 44 keratoconus eyes. A comprehensive ophthalmologic examination was performed in all cases, which included a corneal analysis with the Pentacam system (Oculus). Classical keratometric corneal power (Pk), Gaussian corneal power (PcGauss), True Net Power (TNP) (Gaussian power neglecting the corneal thickness effect), and an adjusted keratometric corneal power (Pkadj) (keratometric power considering a variable keratometric index) were calculated. All cases included in the study were classified according to five different classification systems: Alió-Shabayek, Amsler-Krumeich, Rabinowitz- McDonnell, collaborative longitudinal evaluation of keratoconus (CLEK), and McMahon.

Results: When Pk and Pkadj were compared, differences in the type of grading of keratoconus cases was found in 13.6% of eyes when the Alió-Shabayek or the Amsler-Krumeich systems were used. Likewise, grading differences were observed in 22.7% of eyes with the Rabinowitz-McDonnell and McMahon classification systems and in 31.8% of eyes with the CLEK classification system. All reclassified cases using Pkadj were done in a less severe stage, indicating that the use of Pk may lead to the classification of a cornea as keratoconus, being normal. In general, the results obtained using Pkadj, PcGauss or the TNP were equivalent. Differences between Pkadj and PcGauss were within ± 0.7D.

Conclusion: The use of classical keratometric corneal power may lead to incorrect grading of the severity of keratoconus, with a trend to a more severe grading.

Keywords: Corneal topography, Keratoconus, Pentacam.

How to cite this article: Llorens DPP, Camps V, Caravaca- Arens E. Errors Associated to Keratoconus Grading using Systems based on Corneal Power. Int J Kerat Ect Cor Dis 2015;4(2):41-46.

Source of support: Nil

Conflict of interest: None

 
3.  REVIEW ARTICLE
Corneal Cross-linking can halt the Progression of Keratoconus, but what is the Best Approach to Treatment?
Frederik Raiskup, Mark Hillen
[Pages No:47-51]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1097 | FREE

ABSTRACT

There are a number of treatment options for keratoconus, but only corneal collagen cross-linking (CXL) appears to halt the progression of the disease. To guarantee effective cross-linking, CXL treatment involves removal of the corneal epithelium prior to riboflavin application and ultraviolet light illumination to ensure that riboflavin reaches the collagen in the stroma-epithelial-on cross-linking (‘Epi-off’ CXL). Several methods of ‘Epi-on’ (transepithelial) CXL have been proposed, as keeping the corneal epithelium intact should be less painful and help avoid other CXL-associated adverse events. The evidence to date is that Epi-off CXL remains the most effective method of strengthening the cornea and slowing keratoconus progression-but transepithelial methods are gaining ground.

Keywords: Corneal collagen cross-linking, ‘Epi-off’ crosslinking, ‘Epi-on’ cross-linking, Keratoconus, Transepithelial cross-linking.

How to cite this article: Raiskup F, Hillen M. Corneal Crosslinking can halt the Progression of Keratoconus, but what is the Best Approach to Treatment? Int J Kerat Ect Cor Dis 2015; 4(2):47-51.

Source of support: Nil

Conflict of interest: None

 
4.  REVIEW ARTICLE
Corneal Hydrops in Keratoconus
Prafulla K Maharana, Ritu Nagpal, Namrata Sharma
[Pages No:52-55]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1098 | FREE

ABSTRACT

Purpose: The purpose of this review is to outline the etiology, clinical features, and management of acute corneal hydrops (CH) in cases of keratoconus (KC).

Recent findings: The advent of newer investigative modalities like ultra biomicroscopy, anterior segment optical coherence tomography and confocal microscopy has contributed toward the diagnosis, treatment planning and following the course of therapy in cases of acute hydrops.

Summary: Corneal hydrops is an acute complication of keratoconus which in most instances resolves spontaneously. However, prolonged corneal edema can lead to complications, such as corneal neovascularization which can jeopardise a future corneal graft. Hence, timely intervention is required in most cases to prevent such complications as well as for early visual rehabilitation. Intracameral gas injection is the most commonly performed surgical procedure for hydrops. Modifications in surgical technique can help to tackle difficult situations.

Keywords: Acute corneal hydrops, Corneal edema, Intracameral gas injection, Keratoconus.

How to cite this article: Maharana PK, Nagpal R, Sharma N. Corneal Hydrops in Keratoconus. Int J Kerat Ect Cor Dis 2015;4(2):52-55.

Source of support: Nil

Conflict of interest: None

 
5.  CASE REPORT
Fitting of a New Design of Full Scleral Contact Lens in Advanced Keratoconus with Previous Implantation of Intracorneal Ring Segments
David P Piñero Llorens
[Pages No:56-59]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1099 | FREE

ABSTRACT

This case report reports the visual rehabilitation obtained with the fitting of a new design of full scleral contact lens (ICD 16.5 contact lens, Paragon Vision Sciences, distributed by Lenticon, Madrid, Spain) in a cornea with advanced keratoconus and previous implantation of intracorneal ring segment with a very limited effect. This eye had a refraction of -3.00 × 55° cylinder, providing a visual acuity of 0.5 LogMAR. The topographic pattern was very irregular with the presence of a significant central protrusion and a significant central corneal thinning. Some previous unsuccessful fittings have been performed with corneal and corneal-scleral lenses. A comfortable wearing was achieved with a fully scleral contact lens of 4600 µm of sagittal height, optical power of -11.25 D, and providing an apical clearance of 196 µm. A visual acuity of 0.0 LogMAR combined with a relevant aberrometric improvement was achieved with this contact lens. The patient was completely satisfied with the fitting. The result was maintained during 1 year after the fitting. Full scleral lenses are then able to provide comfortable wear and a significant increase in visual acuity combined with a significant improvement in the visual quality in eyes with advanced keratoconus.

Keywords: Contact lenses, Corneal irregularity corneal asymmetry, Intrastromal corneal rings, Keratoconus, Sirius.

How to cite this article: Llorens DPP. Fitting of a New Design of Full Scleral Contact Lens in Advanced Keratoconus with Previous Implantation of Intracorneal Ring Segments. Int J Kerat Ect Cor Dis 2015;4(2):56-59.

Source of support: Nil

Conflict of interest: None

 
6.  CASE REPORT
Simultaneous Penetrating Keratoplasty with Crescentic Inferior Keratoplasty in Advanced Pellucid Marginal Degeneration
Valentine Saunier, David Smadja, David Touboul
[Pages No:60-62]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1100 | FREE

ABSTRACT

Purpose: To describe and report long-term outcomes of a surgical technique in advanced pellucid marginal degeneration (PMD) combining conventional central penetrating keratoplasty (PK) with an additional crescentic inferior keratoplasty, using a single corneal transplant.

Results: We report the case of a 55-year-old male patient, who underwent a customized sizing PK in his right eye for an advanced PMD, which combined a central PK with an additional crescentic inferior keratoplasty. The 1 year postoperative results show very good clinical outcomes, including visual acuity and biomechanical parameters, as well as tectonic outcomes, documented with high resolution optical coherence tomography (OCT) at the junction site between the two grafts.

Conclusion: Advanced PMD is a specifically challenging condition for keratoplasty due to an extreme peripheral corneal thinning. This surgical technique may facilitate inferior suturing and optimize the postoperative tectonic outcomes.

Keywords: Crescentic keratoplasty, Double keratoplasty, Pellucid marginal corneal degeneration, Penetrating keratoplasty.

How to cite this article: Saunier V, Smadja D, Touboul D. Simultaneous Penetrating Keratoplasty with Crescentic Inferior Keratoplasty in Advanced Pellucid Marginal Degeneration. Int J Kerat Ect Cor Dis 2015;4(2):60-62.

Source of support: Dr Smadja is a paid consultant for Alcon laboratories (Fort Worth, US) and Ziemer System.
Dr Touboul is a paid consultant for Moria Surgical (Antony, France) and Horus pharma (Saint-Laurent du Var, France). The rest of the authors have no financial interest.

Conflict of interest: None

 
7.  CASE REPORT
Corneal Collagen Cross-linking in a Prepubescent 10-Year-Old Girl with Aggressive Keratoconus
Marco Abbondanza, Margherita Guidobaldi
[Pages No:63-65]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1101 | FREE

ABSTRACT

Keratoconus (KC) is a corneal ectatic disease that results in bilateral and asymmetrical corneal distortion, altered refractive powers and reduced vision. In 20 to 25% of cases, corneal transplantation may be required, although a number of conservative procedures are available. We report a case of an aggressive stage II keratoconus in a prepubescent 10-year-old girl, successfully treated with corneal collagen cross-linking (CXL) with epithelium removal.

Keywords: Cornea, Corneal collagen cross-linking, Keratoconus, Pediatric.

How to cite this article: Abbondanza M, Guidobaldi M. Corneal Collagen Cross-linking in a Prepubescent 10-Year- Old Girl with Aggressive Keratoconus. Int J Kerat Ect Cor Dis 2015;4(2):63-65.

Source of support: Nil

Conflict of interest: None

 
8.  CASE REPORT
Long-term Stability of Ectasia in a Young Patient with Asymmetric Keratoconus
Rosane de Oliveira Corrêa, Ana Laura Caiado Canedo, Rozalia Beildeck, Marcella Quaresma Salomão, Penelope Burle de Politis, Renato Ambrósio Jr
[Pages No:66-68]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1102 | FREE

ABSTRACT

Purpose: To report the clinical course of a typical young patient presenting with asymmetric keratoconus (KC), that demonstrates that stabilization of the ectatic process is possible without cross-linking (CXL) procedure.

Methods: Case report and review of the literature.

Results: A 17-year-old male patient was referred due to the diagnosis of keratoconus. Patient complained of loss of vision in the left eye (OS). Uncorrected distance visual acuity (UDVA) was 20/25+ in the right eye (OD) and 20/80 in the left eye; wavefront-assisted manifest refraction gave best corrected distance visual acuity (CDVA) of 20/20 in OD and 20/40 in OS. The diagnosis of keratoconus was confirmed with Placido disk-based topography (Oculus Keratograph 4), and Pentacam HR corneal tomography (Oculus Optikgeräte GmbH, Wetzlar, Germany). Femtosecond laser-assisted intracorneal ring segment (ICRS) implantation was performed in the left eye and treatment for allergy was prescribed for both eyes, along with patient education and advice not to rub the eyes. After 3 months, significant improvement was observed on UDVA (20/30) and CDVA (20/20) in the left eye. Topometric and tomographic stability of ectasia was observed in the right eye in a 4-year follow-up.

Conclusion: Intracorneal ring segment caused significant regularization of the corneal shape and improvement on visual acuity. Ectasia stability was achieved with no need for CXL, despite the patient’s young age. This case raises the point that the indication of CXL for every keratoconic patient should be reconsidered.

Keywords: Cross-linking indication, Intracorneal ring, Keratoconus.

How to cite this article: de Oliveira Correa R, Canedo ALC, Beildeck R, Salomão MQ, de Politis PB, Ambrósio R Jr. Longterm Stability of Ectasia in a Young Patient with Asymmetric Keratoconus. Int J Kerat Ect Cor Dis 2015;4(2):66-68.

Source of support: Nil

Conflict of interest: Dr Ambrósio is a consulant for oculus and wavelight-alcon.

 
9.  CASE REPORT
A Special Design of Intacs SK and Collagen Corneal Cross-linking for the Treatment of Pellucid Marginal Degeneration in a 74-Year-Old Male
Adel Barbara, Ramez Barbara
[Pages No:69-75]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1103 | FREE

ABSTRACT

We present a case report of a 74-year-old male who suffers from advanced and progressive pellucid marginal degeneration in his right eye, his left eye is legally blind because of macular scar.
We performed a combined procedure of a special design Intacs SK insertion followed by epi-off collagen corneal crosslinking according to the Dresden protocol. The Intacs SK were inserted by the manual technique, no intra- or postoperative complications were noted. Two months postoperatively, his uncorrected and best spectacle corrected visual acuity improved, the astigmatism was reduced and regularization of the corneal topography was observed. The patient is very satisfied from the improvement of his vision by minimally invasive procedures.

Keywords: Collagen, Corneal rings, Corneal segments, Crosslinking, ICRS, Intacs, Intrastromal, Keratoconus, Pellucid marginal degeneration, SK, Topography.

How to cite this article: Barbara A, Barbara R. A Special Design of Intacs SK and Collagen Corneal Cross-linking for the Treatment of Pellucid Marginal Degeneration in a 74-Year-Old Male. Int J Kerat Ect Cor Dis 2015;4(2):69-75.

Source of support: Nil

Conflict of interest: None

 
10.  CASE REPORT
MyoRing Treatment of Keratoconus
Albert Daxer
[Pages No:76-83]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1104 | FREE

ABSTRACT

A case of bilateral keratoconus after corneal cross-linking in both eyes and ineffective ring segment implantation in the left eye is presented. The ineffective ring segment was removed and instead, a corneal pocket was created and a MyoRing was inserted. In this case study, the currently available options of treatment are presented and the differences between ring segments and MyoRing are discussed in detail.

Keywords: CISIS, ICRS, Keratoconus, MyoRing, Ring segment.

How to cite this article: Daxer A. MyoRing Treatment of Keratoconus. Int J Kerat Ect Cor Dis 2015;4(2):76-83.

Source of support: Nil

Conflict of interest: The author has a financial interest in DIOPTEX GmbH.
The data have been presented in part at the annual meetings of the ESCRS 2013 (Amsterdam) and 2014 (London) as well as at the Keratoconus Expert Meetings 2012 in Milano and 2013 Amsterdam.

 
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