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International Journal of Keratoconus and Ectatic Corneal Diseases
Current Issue : Volume 5, Issue 3, September-December 2016
 
 
1.  Editorial
Evolution on Keratoconus and Corneal Ectatic Diseases: Paradigms and Paradoxes
Renato Ambrosio, Fernando Faria-Correia, Bernardo Lopes, Marcella Salomão, Michael W Belin
[Pages No:iv-vii]
Full Text PDF | Abstract | FREE

ABSTRACT

The first accurate description of keratoconus is reported to be the treatise on conical cornea published by Dr John Nottingham in London, in 1854. Interestingly, despite the limitations on the knowledge related to anatomy, biochemistry, and physiology of the eye, Nottingham’s seminal work described in detail many aspects of the epidemiology, clinical presentation, and treatment of corneal ectatic diseases are still accurate today.1

 
2.  Original Article
Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking
David P Piñero, Alberto Artola, Pedro Ruiz-Fortes, Roberto Soto-Negro, Rafael J Pérez-Cambrodi
[Pages No:93-98]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1128 | FREE

ABSTRACT

Objective: To assess the clinical outcomes in ectatic corneas following accelerated transepithelial cross-linking (CXL) over 1 year of follow-up.

Materials and methods: Twenty-one eyes diagnosed with progressive corneal ectasia (19 keratoconus, 2 post-laser in situ keratomileusis ectasias) in 14 patients aged between 26 and 69 years were enrolled. All cases were treated with accelerated transepithelial CXL using the Avedro KXL® system (Waltham, MA, United States). Changes at visual, refractive, corneal topographic, and corneal aberrometric level were evaluated over a 12-month follow-up period. The demarcation was also determined using optical coherence tomography (OCT).

Results: The mean depth of the demarcation line measured by OCT was 202.72 μm, varying between 153 and 230 μm. One month postsurgery, a change was noted at the limit of statistical significance in sphere (p = 0.05) and in spherical equivalent (p = 0.05). Likewise, a statistically significant difference was observed in corrected distance visual acuity (CDVA) (p = 0.01). There were no significant changes in either visual acuity or refraction between 1 and 6 months (p ≥ 0.35). Although changes in trend were observed in corneal topographic and aberrometric parameters after surgery, none reached statistical significance (p ≥ 0.08). A significant change was observed only in astigmatism of the posterior surface between 1 and 12 months (p = 0.02).

Conclusion: Accelerated transepithelial CXL may be a useful technique for the management of progressive corneal ectasia, as it is able to maintain the topographic and aberrometric profile of the cornea with no significant changes. Longer-term studies are required to confirm this finding

Keywords: Collagen, Corneal, Ectasia.

How to cite this article: Piñero DP, Artola A, Ruiz-Fortes P, Soto-Negro R, Pérez-Cambrodi RJ. Clinical Outcomes at 1 Year following Corneal Ectasia Treatment with Accelerated Transepithelial Cross-linking. Int J Kerat Ect Cor Dis 2016;5(3):93-98.

Source of support: Nil

Conflict of interest: None

 
3.  Original Article
Keratoconic Cone Using its Keratometry, Decentration, and Thickness as Staging Parameters
Kyaw L Tu, Abdo K Tourkmani, Singaram Srinivas
[Pages No:99-104]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1129 | FREE

ABSTRACT

Aim: To propose a new system of keratoconus staging using a set of parameters describing the keratoconic cone.

Materials and methods: Retrospective case series study of 101 keratoconic eyes of 58 patients was undertaken. They all had complete eye examination including corneal topography (Oculus Pentacam). Kmean, Kmax, higher order aberrations (HOAs) root mean square (HOARMS) value, pachymetry at thinnest point and steepest corneal meridian were obtained from Pentacam. Apex to thinnest pachymetry distance (D) was calculated using trigonometry. Pearson correlation coefficients between Kmax and HOARMS, between D on the one hand and the adjusted angle of steepest meridian, Kmean and Kmax respectively on the other, were calculated.

Results: There is a statistically significant positive correlation between Kmax and HOARMS (p < 0.00001). There is a negative correlation, a “horizontalization,” of the steep meridian with D increase, although it fell short of statistical significance (p = 0.07). D and Kmean (p = 0.003), and D and Kmax (p = 0.005) are significantly negatively correlated.

Conclusion: Kmax correlates with significant changes in HOAs. D correlates with corneal astigmatic meridian change and has a divergent path to Kmean and to Kmax. We propose a new keratometry, decentration, and thinnest pachymetry staging using the parameters Kmax (K), distance from the corneal apex to the thinnest pachymetry point (D), and corneal thickness at its thinnest point (T) to give a better, detailed description of a keratoconic cornea which could lead to improvements in assessment of its severity and treatment outcomes.

Keywords: Decentration, Keratometry, Thickness.

How to cite this article: Tu KL, Tourkmani AK, Srinivas S. Keratoconic Cone using its Keratometry, Decentration and Thickness as Staging Parameters. Int J Kerat Ect Cor Dis 2016;5(3):99-104.

Source of support: Nil

Conflict of interest: None

 
4.  Original Article
Comparison of Anterior Chamber Parameters between Normal and Keratoconus Eyes using Scheimpflug Photography
Nagla Hassan Ali, Mohammed Othman AbdElKhalek, Hanan Elghoneimy
[Pages No:105-108]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1130 | FREE

ABSTRACT

Aim: To evaluate anterior chamber indices including anterior chamber depth (ACD) and anterior chamber volume (ACV) with the progression of keratoconus using a rotating Scheimpflug camera to determine the sensitivity and specificity of these parameters in discriminating keratoconus from normal eyes.

Materials and methods: After full ophthalmological examination in the Memorial Institute of Ophthalmic Research, the patients are divided into two groups: Group I consisting of 50 eyes of normal control. Group II consists of 50 eyes of moderate keratoconus. All the subjects were evaluated with a Pentacam Scheimpflug camera (Oculus, Wetzlar, Germany). Keratoconic eyes were evaluated by vertical asymmetry (VI), keratoconus index (KI), thinnest corneal thickness (TCT) with front elevation at thinnest location (F.Ele.Th) and back elevation at thinnest location (B.Ele.Th) and then divided into three groups according to mean keratometer (K) readings: Mild (K = less than 47.0 D), moderate (K = 47.0 to 52.0 D), and severe (K = 52.0 D or higher), and ACD and ACV were obtained after exclusion of mild and severe cases.

Results: With the progression of the disease, there was statistically significant differences in ACD and ACV measurements between the normal and moderate keratoconus eyes with progressive increase in the ACD and ACV with disease progression.

Conclusion: Anterior chamber parameters including depth and volume showed significant increase with moderate keratoconus than control.

Keywords: Anterior, Photography, Scheimpflug.

How to cite this article: Ali NH, AbdElKhalek MO, El Ghonemy HM. Comparison of Anterior Chamber Parameters between Normal and Keratoconus Eyes using Scheimpflug Photography. Int J Kerat Ect Cor Dis 2016;5(3):105-108.

Source of support: Nil

Conflict of interest: None

 
5.  Original Article
Femto Circular Keratotomy to Halt the Progression of Keratoconus I and II
Jörg H Krumeich, Nino Hirnschall, Detlev Breyer, Florian Laufer
[Pages No:109-113]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1131 | FREE

ABSTRACT

Aim: To simplify and enhance safety in the generation of a stabilizing intracorneal scar by circular keratotomy (CKT). A femtosecond laser was used to perform individually sized intraparenchymal cuts.

Materials and methods: As equipped, the Ziemer Z6 femtosecond laser cuts a 400-ìm-deep incision with a diameter of 7.0 mm around the optical axis. The epithelium, Bowmann’s membrane, the internal borders of Descemet’s membrane, and the endothelium are not affected.
The 3-, 6-, and 12-month postoperative values were compared with the 1-month postoperative keratometric readings and astigmatism. The preoperative best corrected visual acuity (BCVA) with glasses was compared with the values found at the same time points as noted above.

Results: Statistical evaluation indicated that keratometry within ±1.5D remained in 96.6, 93.1, and 96.6% of cases at the 3-, 6-, and 12-month time points respectively.
Astigmatism was stable at the same time points in 100, 95.8, and 92.3%.
The BCVA improved in 12 cases throughout the first postoperative year (48%, n = 25); however, 11 cases did not change (44%) and 2 cases lost at least one line (8.0%).

Conclusion: Femto CKT halts the progression of keratoconus for at least 1 year in 96.6% of cases. This treatment provides keratometric and refractive stability for over 1 year. This result, in conjunction with the significant improvement in BCVA, demonstrates the potential of this method for patients with stage I and II keratoconus.

Keywords: Circular corneal cut, Circular keratotomy, Keratoconus.

How to cite this article: Krumeich JH, Hirnschall N, Breyer D, Laufer F. Femto Circular Keratotomy to Halt the Progression of Keratoconus I and II. Int J Kerat Ect Cor Dis 2016;5(3):109-113.

Source of support: Nil

Conflict of interest: None

 
6.  Review Article
Ferrara Intrastromal Corneal Ring Segments
Leonardo Torquetti, Jordana Sandes, Guilherme Ferrara, Paulo Ferrara
[Pages No:114-127]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1132 | FREE

ABSTRACT

The Ferrara intrastromal corneal ring segments (ICRS) are designed to treat ectatic corneal disorders, especially keratoconus. They have been used to reshape keratoconic corneas to improve uncorrected visual acuity, best-corrected visual acuity, contact lens tolerance and to delay or prevent the need for keratoplasty. Intrastromal corneal ring segments have several distinct and important advantages. The Ferrara ICRS have been used largely in several countries for the treatment of primary and secondary ectatic corneal disorders. This article reviews the latest data published and the clinical experience/findings on the treatment of keratoconus by the Ferrara ICRS implantation.

Keywords: Ferrara, Intrastromal corneal ring segments, Keratoconus.

How to cite this article: Torquetti L, Sandes J, Ferrara G, Ferrara P. Ferrara Intrastromal Corneal Ring Segments. Int J Kerat Ect Cor Dis 2016;5(3):114-127.

Source of support: Nil

Conflict of interest: Dr. Paulo Ferrara and Guilherme Ferrara have proprietary interest in the Ferrara ICRS. Dr. Leonardo Torquetti does not have financial interest in any device cited in this review.

 
7.  Review Article
High-order Aberrations in Keratoconus
Hagar Hefner-Shahar, Nir Erdinest
[Pages No:128-131]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1133 | FREE

ABSTRACT

With all the technological advances today and the increasing number of people undergoing refractive surgery, the importance of detecting keratoconus (KC) prior to surgery has become evident. Although by using a topographer we can detect early stage KC, however, by using wavefront analysis technology, we are able to detect KC at an even earlier stage.
Every eye possesses a number of aberrations. However, in a KC patient’s eye, there are approximately five to six times the numbers of high-order aberrations (HOAs) than in a healthy eye. Using this technology to detect and assess the HOAs, it was found that in a KC cornea, it is possible to detect at a very early stage a much higher value of vertical coma aberrations compared with a normal eye. By using this technology, it is possible to study and understand the characteristics of the quality of the image on the retina, thereby understanding its impact on the patient’s visual quality.

Keywords: Aberrations, High-order, Keratoconus, Vertical coma, Wavefront.

How to cite this article: Hefner-Shahar H, Erdinest N. Highorder Aberrations in Keratoconus. Int J Kerat Ect Cor Dis 2016;5(3):128-131.

Source of support: Nil

Conflict of interest: None

 
8.  Case Series
Keratoconic Bi-aspheric Contact Lenses
Liat Gantz, Ariela Gordon-Shaag, Arige Gideon-Abousaid, Gad Serero, Philip Fine
[Pages No:132-138]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1134 | FREE

ABSTRACT

Aim: This observational clinical case series examined patients with keratoconus (KC) fit with keratoconic bi-aspheric (KBA) lenses to assess visual acuity (VA), wavefront aberrations, physiological fitting, subjective comfort, and manufacturer’s fitting guidelines.

Materials and methods: Seven adult patients (11 eyes, four females, mean age: 34.15 ± 14.12) with nipple cones from the Hadassah Academic College contact lens clinic (Jerusalem, Israel) were fit with KBA lenses by modifying the initial base curve (BC) to obtain an acceptable physiological fit. The uncorrected and corrected distance (D) and near (N) Snellen VA and the ocular wavefront measurements, and responses to a self-administered five-point scale questionnaire were compared after 2 weeks of wear using paired two-tailed t-test or Mann- Whitney U test, as appropriate.

Results: Visual acuity and total root mean square (RMS) improved significantly with the lenses (DVAuncorrected = 0.04 ± 0.02, DVAcorrected = 0.66 ± 0.22, NVAuncorrected = 0.34 ± 0.30, NVAcorrected = 0.95 ± 0.12). Subjects reported an average of 7.0 ± 2.7 hours of wear daily, with good scores in visual stability, satisfaction with VA and quality of vision, improvement of mood and quality of life, and low scores in foreign body sensation, pain, red eye, and itching during wear, and difficulty with lens removal. An average of two BC modifications from the diagnostic lens were necessary (0.16 mm steeper in nine eyes, 0.27 mm flatter in two eyes).

Conclusion: Keratoconic bi-aspheric lenses can provide 7 hours of comfortable wear, significantly improved VA and total RMS aberrations, alongside subjective satisfaction. Base curve modifications can be reduced by fitting a diagnostic lens 0.75 mm steeper than the flattest keratometry reading.

Keywords: Contact lenses, Gas permeable contact lenses, Higher order aberrations, Keratoconus, Visual acuity.

How to cite this article: Gantz L, Gordon-Shaag A, Gideon- Abousaid A, Serero G, Fine P. Keratoconic Bi-aspheric Contact Lenses. Int J Kerat Ect Cor Dis 2016;5(3):132-138.

Source of support: Nil

Conflict of interest: None

 
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