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International Journal of Keratoconus and Ectatic Corneal Diseases
Current Issue : Volume 3, Issue 1, January-April 2014
 
 
1.  Editorial
Editorial
Adel Barbara
[Pages No:v]
Full Text PDF | Abstract | FREE

Editorial

I am delighted to present the 7th issue of the International Journal of Keratoconus and Ectatic Corneal Diseases. Indeed, we have completed 2 years of publishing in this journal, accounting for six issues, and here we are in our 3rd year.

 
2.  Original Article
Independent Population Validation of the Belin/Ambrosio Enhanced Ectasia Display: Implications for Keratoconus Studies and Screening
Ovette F Villavicencio, Fatimah Gilani, Maria A Henriquez, Luis Izquierdo Jr, Renato R Ambrosio Jr, Michael W Belin
[Pages No:1-8]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1069 | FREE

ABSTRACT

With advances in technology and imaging, finding diagnostic criteria that are both sensitive and specific for keratoconus while using the latest corneal imaging modalities is paramount. The Belin/Ambrosio enhanced ectasia display final 'D' index, tested on an independent population, illustrated excellent false positive rates for refractive screening while eliminating 99% of keratoconus corneas. A false positive rate of 0% is achieved with a final 'D' of 2.69, meeting the more stringent criteria for treatment studies.

Keywords: Keratoconus, Ectasia, Tomography, Cornea, Imaging, Refractive surgery, Cross-linking, Scheimpflug, Placido, Topography.

How to cite this article: Villavicencio OF, Gilani F, Henriquez MA, Izquierdo L Jr, Ambrosio RR Jr, Belin MW. Independent Population Validation of the Belin/Ambrosio Enhanced Ectasia Display: Implications for Keratoconus Studies and Screening. Int J Kerat Ect Cor Dis 2014;3(1):1-8.

Source of support: Nil

Conflict of interest: Drs Ambrosio and Belin are consultant to OCULUS GmbH.

 
3.  Original Article
Prevalence of Keratoconus among Young Arab Students in Israel
Einat Shneor, Michel Millodot, Ariela Gordon-Shaag, Maron Essa, Miriam Anton, Ramez Barbara, Adel Barbara
[Pages No:9-14]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1070 | FREE

ABSTRACT

Purpose: To determine the prevalence of keratoconus (KC) in an Arab population in Israel.

Materials and methods: Videokeratography was performed on volunteer students from the Academic Arab College of Education, in Haifa, Israel. All participants filled out a selfadministered questionnaire to evaluate possible risk factors for KC. Univariate and multivariate analysis were performed.

Results: Data of 314 participants were analyzed and a prevalence of (N = 10), 3.18% (95% CI, 1.2 to 5.1%) was found. The only significant factor (both in univariate and multivariate analysis) that was associated with KC was parental consanguinity (OR 5.10, p = 0.02). Druzes and Bedouins had a higher prevalence than Muslims and Christians. However, the differences were not significant possibly due to the small size of the sample.

Conclusion: The result of this study was similar to other studies conducted in the Middle East, which indicate a higher prevalence of KC than in western countries. It is also recommended that people who have consanguinity in their family should be topographically tested to detect the early stages of KC.

Keywords: Keratoconus, Consanguinity, Videokeratography.

How to cite this article: Shneor E, Millodot M, Gordon-Shaag A, Essa M, Anton M, Barbara R, Barbara A. Prevalence of Keratoconus among Young Arab Students in Israel. Int J Kerat Ect Cor Dis 2014;3(1):9-14.

Source of support: Nil

Conflict of interest: None declared

 
4.  Original Article
Corneal Thickness after MyoRing Implantation for Keratoconus
Albert Daxer
[Pages No:15-19]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1071 | FREE

ABSTRACT

Purpose: To analyze the corneal thickness development after MyoRing implantation as a tissue-related indicator of keratoconus progression.

Materials and methods: Twelve eyes suffering from keratoconus were treated for visual rehabilitation by means of MyoRing implantation into a corneal pocket. The postoperative development of the corneal thickness at the thinnest point was analyzed. Follow-up ranged from 16 to 74 months (mean 37 months).

Results: Out of the 12 eyes only one eye showed a thinner cornea at the last follow-up 60 months after MyoRing implan-tation compared to the last preoperative data. None of these 12 eyes required an additional intervention like corneal cross-linking, explantation or keratoplasty. Four eyes showed even thickening of the cornea during the postoperative period.

Conclusion: MyoRing implantation for keratoconus does not only allow visual rehabilitation. It also seems to stop the progression of the disease by creating a new biomechanical equilibrium within the tissue which eliminates a constant stimulus that drives the vicious circle of progression.

Keywords: Keratoconus, MyoRing, Corneal thickness, Progression, Corneal cross-linking, PocketMaker.

How to cite this article: Daxer A. Corneal Thickness after MyoRing Implantation for Keratoconus. Int J Kerat Ect Cor Dis 2014;3(1):15-19.

Source of support: Nil

Conflict of interest: None declared

 
5.  Original Article
MyoRing Treatment for Cases of Myopia not eligible for Laser Vision Correction
Albert Daxer
[Pages No:20-22]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1072 | FREE

ABSTRACT

Purpose: MyoRing implantation has been shown to be able to mechanically stabilize ectatic corneas like a bone-nail for broken legs do. Here I present typical cases of MyoRing treatment for Myopia which were not eligible for LASIK.

Materials and methods: Four eyes of four patients suffering from moderate to high myopia and showing risk factors for postoperative ectasia have been treated by MyoRing implantation. Two of them have been combined with laser vision correction (LVC).

Results: The refractive results are comparable to those published for LVC. The cases with combined MyoRing LASIK treatment performed slightly better postoperatively than those treated with MyoRing only.

Conclusion: MyoRing implantation is safe and effective in myopic cases presenting with mainfest signs of keratoconus. In myopic eyes without manifest keratoconus but risk factors for post-LASIK keratectasia the combination of MyoRing implantation with Excimer Laser Surface Ablation may be a good treatment option.

Keywords: Myopia, MyoRing, Lasik, LVC, Keratectasia, PocketMaker, Wavelight, CISIS.

How to cite this article: Daxer A. MyoRing Treatment for Cases of Myopia not eligible for Laser Vision Correction. Int J Kerat Ect Cor Dis 2014;3(1):20-22.

Source of support: Nil

Conflict of interest: None declared

 
6.  Original Article
Corneal Biomechanical Properties Post-LASEK for the Correction of Myopia
Ramez Barbara, Ali Nassar, David Zadok, Adel Barbara
[Pages No:23-28]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1073 | FREE

ABSTRACT

Introduction: Laser surgeries are effective and safe, however, over the years data has accumulated about several complications of the procedures, particularly corneal ectasia. Various studies demonstrated the importance of the front layers of the cornea to keep its structure fixed. In order to correct various degrees of myopia, different thicknesses of tissue have to be removed. Therefore, it is conceivable that the risk of developing ectasia might increase depending on the depth of corneal tissue removed.
In the last few years, the Reichert Ocular Respond Analyzer (ORA) for measuring the biomechanical parameters of the cornea has been introduced. Studies demonstrated a decrease in the corneal biomechanical parameters after Laser Assisted Sub-Epithelial Keratomileusis (LASEK) surgery. However, the, relation between the depth of tissue removed and the amount of change in the biomechanical parameters had not been tested yet.

Purpose: To evaluate the relationship between corneal biomechanical parameters and corneal tissue ablation thickness.

Methods: Data was retrospectively collected from patient's files that underwent LASEK in private medical center - Hadassah Optimal in Haifa between January 2009 and May 2010. All patients were operated by same surgeon (AB). In our study we included patients that had at least three ORA measurements at three set periods of time; before the operation, up to 3 months postoperative and more than 3 months postoperative. We divided the patients into 3 groups depending on the refractive error and tested the effect of variable factors (Age, Total depth ablated-TDA, percent of total depth ablated-%TDA, sex, refraction). The data was analyzed by descriptive statistics and student t-test to find the relation between LASEK and the corneal biomechanical parameters.

Results: Ninety-eight patients participated in our study, which included 98 separate eye operations. A statistically significant decrease (p < 0.001) was found in CRF, CH, IOPg after LASEK. In group 1 (refraction -0.5 to -2.99): on CH - there was a statistically significant (p < 0.05) weak-moderate effect of TDA and %TDA (Pearson coefficient of 0.4, 0.39 respectively), statistically significant (p < 0.05) effect of age. On CRF — we found a statistically significant (p < 0.05) weak-moderate effect of TDA and %TDA (Pearson coefficient of 0.36 for both factors), statistically significant (p < 0.05) effect of age. In the second group (refraction value -3 to -5.99) only on IOPg a statistically significant (p < 0.05) weak effect of TDA (Pearson coefficient of 0.33) was demonstrated. In the third group, we did not find any effect of the variable factors on the change in biomechanical properties characteristics after LASEK.

Importance: Corneal biomechanical properties influence corneal behavior in certain eye diseases. Moreover, it has been noted that operations and procedures affect these biomechanical properties of the cornea. Hence, it is of great importance to reveal factors that could affect and change such parameters.

Keywords: Lasek , Corneal biomechanics, Corneal hysteresis, Corneal resistance factor, Pachymetry, Corneal thickness, Intraocular pressure, Laser, Cornea.

How to cite this article: Barbara R, Nassar A, Zadok D, Barbara A. Corneal Biomechanical Properties Post-LASEK for the Correction of Myopia. Int J Kerat Ect Cor Dis 2014;3(1):23-28.

Source of support: Nil

Conflict of interest: None

 
7.  Original Article
Implantable Collamer Lens for Correction of Refractive Errors in Patients with Keratoconus following Collagen Cross-Linking: One Year Follow-up
Hassenien Safa Shuber
[Pages No:29-35]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1074 | FREE

ABSTRACT

Objective: The purpose of this study is to assess the predictability, safety, efficacy and stability of correction of refractive errors in patients with keratoconus using Visian implantable collamer lens (ICL) following collagen cross-linking.

Materials and methods: This prospective, non-comparative study evaluated 20 eyes of 14 patients with keratoconus subjected to implantation of intraocular collamer lens at least 1 year following collagen cross-linking and stable refraction. Mean preoperative myopia was -8.43 ± 5.13 Diopters (D) (-3.5 to -20.0D and mean cylinder was -2.19 ± 1.28D (0.0 to -4.5D). The preoperative spherical equivalent (SE) was -9.52 ± 5.33D (-3.75 to -21.25D). During the 12 months follow-up, uncorrected visual acuity, best corrected visual acuity, refraction, intraocular pressure and vaulting are measured.

Results: At 12 months postoperatively, 90% of eye had refractive cylinder of <1.0D with (p = 0.003) and 20 (100%) eyes was within ±0.75D of sphere at 1 year (r2 = 0.99) and (p = 0.0085). The mean postoperative BCVA in decimal was 0.498 ± 0.232, while the mean preoperative BCVA was 0.484 ± 0.285. The safety index at 12 months was 1.02. The mean postoperative UCVA in decimal was 0.498 ± 0.232 and the mean preoperative BCVA is 0.484 ± 0.29 and the efficacy index at 12 months was 1.01.

Conclusion: Implantation of Visian Intraocular collamer lens is predictable, safe and effective way to correct refractive error in patients with keratoconus following collagen cross-linking.

Keywords: Keratoconus, Intraocular collamer lens, Collagen cross linking.

How to cite this article: Shuber HS. Implantable Collamer Lens for Correction of Refractive Errors in Patients with Keratoconus following Collagen Cross-Linking: One Year Follow-up. Int J Kerat Ect Cor Dis 2014;3(1):29-35.

Source of support: Nil

Conflict of interest: None

 
8.  Cross-Sectional Study
Corneal Elevation Values in Normal Eyes, forme fruste Keratoconus and Keratoconus at Different Stages Measured by Scheimpflug Imaging
Maria A Henriquez, Luis Izquierdo Jr, David Danin
[Pages No:36-39]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1075 | FREE

ABSTRACT

Purpose: To compare corneal elevation values in normal eyes, forme fruste keratoconus (FFKC) and different stages of keratoconus using Scheimpflug imaging.

Materials and methods: This prospective, comparative study included 267 eyes (107 normal eyes, 21 FFKC and 139 keratoconus). Keratoconic eyes were divided into four groups according to keratometry values. Maximum posterior elevation (PE) above the (best fit sphere (BFS) at the central 5 mm were measured using the Pentacam (Oculus Optikgeräte GmbH). Receiver operating characteristic curves were used to determine the test’s overall predictive accuracy and to identify optimal cutoff points to discriminate between the groups.

Results: PE had the smallest values in normal eyes and increased in FFKC and each progressive stage of keratoconus. Mean PE was 9.98 ± 5.33 µm in normal eyes, 18.09 ± 9.23 µm in FFKC and 24.97 µm ± 15.89, 37.82 ± 18.64, 46.82 ± 21.41 and 66.07 ± 39.09, in keratoconus stage I, II, III and IV respectively.

Conclusion: Posterior elevation values increased according to the severity of keratoconus disease. PE can be used as indicator of keratoconus progression.

Keywords: Keratoconus, Scheimpflug imaging, Posterior elevation, Amsler-Krumeich.

How to cite this article: Henriquez MA, Izquierdo L Jr, Dañin D. Corneal Elevation Values in Normal Eyes, forme fruste Keratoconus and Keratoconus at Different Stages Measured by Scheimpflug Imaging. Int J Kerat Ect Cor Dis 2014;3(1):36-39.

Source of support: Nil

Conflict of interest: None declared

 
9.  Case Report
Long-term Improvement after the Athens Protocol for Advanced Keratoconus with Significant Ectasia Progression in the Fellow Eye
Luis Claudio Pereira, Renata Siqueira, Bruno Valbon, Rodrigo Santos, Daniel Dawson, Renato Ambrosio, Jorge Augusto Siqueira
[Pages No:40-43]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1076 | FREE

ABSTRACT

To describe the long-term result of the Athens protocol (custom topography-guided advanced surface ablation followed by riboflavin-UVA collagen cross-linking in the same day) for progressive advanced keratoconus in the left eye, while the fellow right eye first presented with relatively mild keratoconus that was treated with a more conservative therapeutic approach of continuous contact lenses use with the goal for ectasia stabilization. Five years after the Athens protocol, a regression of over 10D (diopters) was observed on the sagittal curvature with significant regularization of corneal shape and improvement of distance corrected visual acuity (DCVA) in the left eye. The right eye, which was treated more conservatively, had an over 12 D increase on sagittal curvature along with significant distortion of the corneal shape and reduction of DCVA.

Keywords: Keratoconus, Athens protocol, Contact lens.

How to cite this article: Pereira LC, Siqueira R, Valbon B, Santos R, Dawson D, Ambrósio R, Siqueira JA. Long-term Improvement after the Athens Protocol for Advanced Keratoconus with Significant Ectasia Progression in the Fellow Eye. Int J Kerat Ect Cor Dis 2014;3(1):40-43.

Source of support: Nil

Conflict of interest: None declared

 
10.  Case Report
Post Lasik Keratoectasia Developing with Sleep Apnea and Floppy Eyelid Syndrome: Case Report and Review of the Literature
Noa Avni-Zauberman, David S Rootman
[Pages No:44-46]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1077 | FREE

ABSTRACT

We report a case of unilateral keratoectasia in a patient who underwent uneventful hyperopic LASIK 8 years prior and was diagnosed with obstructive sleep apnea syndrome (OSAS) and Floppy eyelid syndrome. The before and after LASIK topographies demonstrated clear development of the ectasia after the patient developed OSAS. The patient was treated with collagen crosslinking in the involved eye to stop ectatic progression. Our report emphasizes the importance of inquiring about the patient’s sleeping postures and habits (specifically asking about OSAS) and a careful examination of eyelid laxity prior to refractive laser treatment.

Keywords: Post-LASIK ectasia, Floppy eyelid syndrome, Obstructive sleep apnea syndrome.

How to cite this article: Zauberman NA, Rootman DS. Post- Lasik Keratoectasia Developing with Sleep Apnea and Floppy Eyelid Syndrome: Case Report and Review of the Literature. Int J Kerat Ect Cor Dis 2014;3(1):44-46.

Source of support: Nil

Conflict of interest: None

 
11.  Case Report
Unilateral Post-Lasik Ectasia in a Topographical Normal Eye with a Slight Asymmetry in the Contralateral Eye
Marouen Berguiga, Alain Saad, Damien Gatinel
[Pages No:47-51]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1078 | FREE

ABSTRACT

Purpose: To report a case of post-lasik unilateral corneal ectasia.

Setting: Department of Anterior Segment and Refractive Surgery, Rothschild Foundation, Paris.

Case report: A 33-year-old woman was referred with a history of unilateral post-Lasik ectasia in her left eye, 18 months post operatively. Her best-corrected visual acuity was 20/20 with a manifest refraction of +1.75 (–4.75 × 90). Orbscan II® revealed an inferior steepening associated with irregular astigmatism. The preoperative Placido topographies revealed a slight skewed radial axis in the right eye associated with an inferior-superior keratometry difference of 1.6 Diopters at 3 mm. In the left eye that developed ectasia, regular symmetric astigmatism was present. Uncorrected visual acuity improved to 20/25 2 weeks after KeraRing® segment insertion.

Keywords: LASIK, Ectasia, Intrastromal corneal ring segments, Femtosecond.

How to cite this article: Berguiga M, Saad A, Gatinel D. Unilateral Post-Lasik Ectasia in a Topographical Normal Eye with a Slight Asymmetry in the Contralateral Eye. Int J Kerat Ect Cor Dis 2014;3(1):47-51.

Source of support: Nil

Conflict of interest: None declared

 
 
     

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