To analyze change in visual acuity (VA), refractive outcomes, corneal compensated intraocular pressure (IOPcc), corneal hysteresis (CH) and cornea resistance factor (CRF) after transepithelial cross-linking (CXL) treatment.

Kudret Eye Hospital, Ankara, Turkey

A total of 32 eyes of 22 patients diagnosed with keratoconus were included in this retrospective study. Changes in VA, spheric and cylinderic refraction for all eyes were analyzed before and 3 months after transepithelial CXL. In addition, a subset of 14 eyes had data acquired using the ocular response analyzer (ORA), and for these eyes, IOPcc, CH and CRF were recorded as well as a measurement of the amplitude of the first peak in the infrared signal (peak 1), used to identify the inward applanation event. The ORA parameters were also compared before and 3 months after treatment.

Uncorrected and best corrected VA increased 1.76 and 1.61 Snellen lines (p < 0.05); spheric and cylinderic refractions improved 0.74 and 0.43 D (p > 0.05) respectively. Mean changes in IOPcc, CRF and CH were not significantly different (p > 0.05). However, mean peak 1 signal value increased significantly (p < 0.05).

Transepithelial CXL is effective in VA improvement in the short-term with an increase in the peak 1 signal value which is consistent with an increase in stiffness of cornea, whereas IOPcc, CRF and CH values remained the same.

Klllç A, Roberts CJ. Biomechanical and Refractive Results of Transepithelial Cross-linking Treatment in Keratoconic Eyes. Int J Kerat Ect Cor Dis 2012;1(2):75-78.

To report a new grading system of Keratoconus according to visual limitation and to provide the intrastromal corneal ring segments (ICRS) outcomes that can be expected based on preoperative visual impairment.

Alio JL, Burguera-Gimenez N, Vega- Estrada A. Relevance of a New Integral Keratoconus Grading System for the Outcomes of Intracorneal Ring Segment Implantation. Int J Kerat Ect Cor Dis 2012;1(2):79-86.

To evaluate the corneal asphericity, volume, thickness and keratometry and the correlation among these variables in keratoconus patients.

A total of 1,071 eyes of 810 patients diagnosed with keratoconus were evaluated with a Pentacam (Oculus Optikgerate GmbH). Five groups were established according to the mean keratometry readings: Very mild [K < 44.0 diopters (D)], mild (K = 44.0-47.0D), moderate (K = 47.0-52.0D), severe (K = 52.0-60.0D) and very severe (K = 60.0 or higher). The following parameters were obtained: Anterior corneal asphericity (Q), corneal volume (CV) and thinnest corneal thickness (TCT).

Sixty-six eyes had very mild keratoconus, 269 had mild keratoconus, 465 had moderate keratoconus, 233 had severe keratoconus and 38 had very severe keratoconus. As the severity of disease increases, there is an increment in K and CV values and reduction of Q and TCT. There was a statistically significant difference in values for all parameters, except the CV. The Pearson correlation index showed an inverse correlation between the degree of keratoconus and the asphericity (Q), i.e. the more severe the keratoconus the more negative the Q-value. Only in the very severe group there was no statistically significant correlation between K and Q. There was no correlation between severity of keratoconus and CV. There was an inverse correlation between keratoconus grade and TCT; the more advanced the disease the less the TCT value. Only in the very mild group there was no correlation between K and TCT.

The corneal asphericity and pachymetry are inversely correlated to keratometry in keratoconus patients. There is no correlation between CV and severity of keratoconus.

Torquetti L, Ferrara G, Ferrara P. Correlation of Anterior Segment Parameters in Keratoconus Patients. Int J Kerat Ect Cor Dis 2012;1(2):87-91.

To compare topometric (front surface curvature) and tomographic (3D corneal shape) indices for diagnosing keratoconus.

Pentacam data from one eye randomly selected of 200 normals (N) and 177 keratoconus (KC) were analyzed. Tomographic and topometric indices were tested. Receiver operating characteristic (ROC) curves were calculated, along with pairwise comparisons.

All tested variables had significant differences among N and KC (Mann-Whitney, p < 0.001). Most accurate tomographic indices had higher AUC than best topometric ones (DeLong, p < 0.05). Belin-Ambrosio D (BAD-D) had AUC of 1.00 (sensitivity 100.0%; specificity 98.5%).

Tomographic data was superior than topometric data to detect keratoconus. The BAD-D was an enhanced approach for detecting keratoconus.

Correia FF, Ramos I, Lopes B, Salomão MQ, Luz A, Correa RO, Belin MW, Ambrósio R Jr. Topometric and Tomographic Indices for the Diagnosis of Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):92-99.

To evaluate the accuracy of a new objective method for the detection of ectasia susceptible eyes.

One hundred and eighty-three elevation and placido topographies were retrospectively evaluated by one experimented refractive surgeon and classified as ‘normal’ or ‘at risk for LASIK’. An objective automated system built on the combination of topography and tomography data in a discriminant function was also used to classify the corneas. The concordance between the objective and the subjective classification was evaluated and the usefulness of the objective scoring system was assessed by receiver operating characteristic (ROC) curve analysis.

The mean age of the studied group was 37 ± 8 years old. One hundred and fifty-nine eyes were subjectively classified as ‘normal’ and 24 as ‘At risk for LASIK’. The scoring system correctly classified 153 eyes as ‘normal’ and 22 eyes as ‘at risk for LASIK’. Six eyes were wrongly detected as ‘at risk’ by the automated system (false-positive) and two eyes were wrongly classified as ‘normal’ (false-negative). The sensitivity and specificity of the automated system were 92 and 96% respectively.

An automated system built on the combination of topography and tomography parameters can help in creating a sensitive and specific artificial intelligence for the detection of corneas at risk for refractive surgery.

Saad A, Gatinel D. Validation of a New Scoring System for the Detection of Early Forme of Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):100-108.

To evaluate the efficacy of the combined treatment of Intacs SK (Severe keratoconus) and corneal collagen cross- linking in the management of advanced keratoconus (KC).

Private laser center, Haifa, Israel. Affiliated to Hadassah Hospital, Jerusalem.

This is a retrospective study. Intacs SK were implanted using manual technique in eyes with moderate-to- severe keratoconus followed by collagen corneal cross-linking (CXL). Evaluation included uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction, slit-lamp examination and corneal topography. Ocular response analyzer (ORA) was used to assess the corneal hysteresis (CH) and the corneal resistance factor (CRF).

We report on improvement of the UCVA, BSCVA, decrease in myopia, astigmatism and keratometry readings. No significant change in CRF or CH was noted.

The combined treatment of Intacs SK and corneal CXL for the treatment of advanced keratoconus is safe and effective. The combined treatment resulted in improved UCVA, BSCVA, keratometry readings and regularization of the topography but no significant change in CRF and HS.

Barbara R, Garzozi H, Barbara A. Combined Intacs SK and Corneal Collagen Cross-linking for the Treatment of Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):109-116.

To demonstrate treatment options for keratoconus using MyoRing intracorneal implant in central and noncentral cones.

Five eyes with central and noncentral cones were compared in a retrospective study.

In central cones the maximum of the flattening effect is in the corneal center while in noncentral cones the maximum of the flattening is in area of the cone.

No matter where the cone location is the implantation of MyoRing intracorneal implants always results in a regularization of the central cornea.

Daxer A. MyoRing for Central and Noncentral Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):117-119.

Tuffaha BT, Alio JL, Piñero DP. Cross- linking for the Management of Pellucid Marginal Degeneration in a Case of an Unsuccessful Implantation of Intracorneal Ring Segments. Int J Kerat Ect Cor Dis 2012;1(2):120-124.

To develop a method of producing the transplant for Descemet stripping endothelial keratoplasty using the PocketMaker device (Dioptex, Austria).

A new application of the PocketMaker microkeratome (Dioptex) is described for preparing thin grafts for endothelial keratoplasty. We report a case of Descemet's membrane detachment treated with a PocketMaker-prepared graft 110 mK thick.

Visual acuity increased from 0.05 to 0.6. The 106 µm thick (in the center) graft remained attached and clear after Descemet stripping PocketMaker endothelial keratoplasty (DSPEK).

DSPEK is another use for the PocketMaker device, which can create thin endothelial grafts about 100 µm thick.

Bikbova G, Bikbov M, Daxer A. Descemet Stripping PocketMaker Endothelial Keratoplasty. Int J Kerat Ect Cor Dis 2012;1(2):125-127.

Levy J, Pitchkhadze A, Lifshitz T. Treatment of Stable Keratoconus by Cataract Surgery with Toric IOL Implantation. Int J Kerat Ect Cor Dis 2012;1(2):128-130.

Marcovich AL. Asymmetrical Corneal Topography in Map-Dot-Fingerprint Dystrophy Resembling Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):131-133.

Barbara R, Garzozi H, Barbara A, Pickel Y, Barua A. Collagen Corneal Cross-linking in a Keratoconic Eye with Diffuse Corneal Edema. Int J Kerat Ect Cor Dis 2012;1(2):134-139.

Kymionis GD, Limnopoulou AN, Stojanovic N, Plaka AD, Kankariya VP. Ring-Shaped Corneal Stromal Opacities after Corneal Cross-linking with Riboflavin and Ultraviolet A Irradiation for Keratoconus. Int J Kerat Ect Cor Dis 2012;1(2):140-143.