To present refractive, visual and topographic outcomes of femtosecond laser assisted intrastromal ring segments (ISRS) implantation.

Bascom Palmer Eye Institute, Miami, FL, USA.

Nineteen eyes of 15 patients with keratoconus, clear central corneas, and contact lens intolerance had implantation of a symmetrical 0.45 mm Inta cs segment (Addition Technology Inc, California, USA) using 200 kHz femtosecond laser (WaveLight GmbH, Erlangen, Germany). The outcomes of the procedure were evaluated in terms of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), average keratometry value (K-value) and spheric equivalent (SE).

Femtosecond laser assisted ISRS implantation could be performed with ease, while no intra- or postoperative complications were encountered. Mean UCVA improved from 0.95 ± 0.39 to 0.66 ± 0.28 logMAR, mean BSCVA improved from 0.46 ± 0.13 to 0.29 ± 0.21 logMAR, mean spherical equivalent considerably reduced from −7.15 ± 4.57 to −4.38 ± 4.07 and K value reduced from 52.39 ± 5.79 to 49.78 ± 6.84 D at the last follow-up.

Using a 200 kHz femtosecond laser is a safe procedure providing optimal refractive, visual and topographic outcomes in our preliminary study.

Ozulken K, Cabot F, Kankariya VP, Yoo SH. Preliminary Results of Femtosecond Laser Assisted Corneal Ring Segment Implantation for Keratoconus. Int J Kerat Ect Cor Dis 2013;2(2):47-50.

To report the first clinical results of application Ferrara's technique of deep anterior lamellar keratoplasty (FDALK) in patients with keratoconus.

Thirty-four eyes of 34 patients with advanced keratoconus were included in the study. All patients were operated by the FDALK technique. Preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal topography and corneal astigmatism were evaluated. Intra- and postoperative complications are described.

Uncorrected visual acuity improved in from 20/400 to 20/125; corrected visual acuity improved from 20/300 to 20/48. The mean follow-up was 19.3 months (sd: 7.1). Corneal topography (Pentacam®) showed significant corneal flattening in all cases. Microperforations of the Descemet's membrane, requiring conversion to penetrating keratoplasty, occurred in two cases.

The FDALK technique is a safe and effective technique to be applied in patients with keratoconus. Visual outcome is comparable to PK, with advantage of preserving recipient endothelium, which lessens the risk of endothelium rejection.

Ferrara P, Ferrara G, Torquetti L. Ferrara Technique of Deep Anterior Lamellar Keratoplasty for Keratoconus Treatment. Int J Kerat Ect Cor Dis 2013;2(2):51-55.

To evaluate optical quality and visual function in keratoconus patients corrected with RGP contact lenses and a novel special design of silicone hydrogel contact lens.

Twelve eyes of six patients with keratoconus were enrolled to experience a new soft contact lens (Soft-K) for keratoconus made of a silicone-hydrogel material and the outcomes were compared to the performance with gas permeable lenses and spectacles. The three situations were compared for monocular and binocular high (100%) and low contrast (10%) ETDRS LogMAR visual acuity and contrast sensitivity function (CSF).

On average, there was an improvement of more than two lines in visual acuity over spectacle correction and this is statistically significant for both gas permeable (GP) and Soft-K lens (p < 0.001). Visual acuity was not significantly different between GP and Soft-K lens for high contrast acuity but was slightly higher with GP lens for low contrast under binocular conditions. Monocular CSF showed a marked improvement with the Soft-K lens and GP, compared to spectacles correction, particularly for medium and high frequencies; conversely.

Soft-K silicone hydrogel soft contact lens produces a clinical and statistically significant improvement in visual acuity and contrast sensitivity function over spectacle correction.

González-Méijome JM, Peixoto-de- Matos SC, Queiros A, Jorge JM, Diaz-Rey A. Quality of Vision with Spectacles, Special Silicone Hydrogel and Gas Permeable Contact Lenses in Keratoconic Patients. Int J Kerat Ect Cor Dis 2013;2(2):56-59.

To provide an overview of the topographic and tomographic indices developed for detecting keratoconus (KC) and subclinical keratoconus.

Literature review of studies describing and testing KC indices as well as indices developed for improving the sensitivity of subclinical KC detection.

Several indices, based on anterior and posterior curvature measurements, corneal spatial distribution or posterior corneal elevation have been developed for improving the detection of KC and subclinical KC. However, to date, none of them could reach, alone, sufficient discriminating power for differentiating the mildest forms of the disease from normal corneas. New detection programs, based on a combination of corneal indices, and generated using artificial intelligence emerged recently and helped to significantly improve the subclinical KC detection.

The combination of topographic and tomographic corneal indices has helped to significantly improve the sensitivity of subclinical KC detection. However, combining these morphological indices to wavefront and biomechanical analyses of the cornea will certainly further improve the sensitivity of the future screening tests.

Smadja D. Topographic and Tomographic Indices for Detecting Keratoconus and Subclinical Keratoconus: A Systematic Review. Int J Kerat Ect Cor Dis 2013;2(2):60-64.

Barbara R, Barbara A. Recurrent Keratoconus. Int J Kerat Ect Cor Dis 2013;2(2):65-68.

To report the successful outcome obtained after fitting a new hybrid contact lens in a cornea with an area of donor-host misalignment and significant levels of irregular astigmatism after penetrating keratoplasty (PKP).

A 41-year-old female with bilateral asymmetric keratoconus underwent PKP in her left eye due to the advanced status of the disease. One year after surgery, the patient referred a poor visual acuity and quality in this eye. The fitting of different types of rigid gas permeable contact lenses was performed, but with an unsuccessful outcome due to contact lens stability problems and uncomfortable wear. Scheimpflug imaging evaluation revealed that a donor-host misalignment was present at the nasal area. Contact lens fitting with a reverse geometry hybrid contact lens (Clearkone, SynergEyes Carlsbad) was then fitted. Visual, refractive, and ocular aberrometric outcomes were evaluated during a 1-year period after the fitting.

Uncorrected distance visual acuity improved from a prefitting value of 20/200 to a best corrected postfitting value of 20/20. Prefitting manifest refraction was +5.00 sphere and .5.50 cylinder at 75°, with a corrected distance visual acuity of 20/30. Higher order root mean square (RMS) for a 5 mm pupil changed from a prefitting value of 6.83 μm to a postfitting value of 1.57 μm (5 mm pupil). The contact lens wearing was referred as comfortable, with no anterior segment alterations.

The SynergEyes Clearkone contact lens seems to be another potentially useful option for the visual rehabilitation after PKP, especially in cases of donor-host misalignment.

Pérez-Cambrodí RJ, Ruiz-Fortes P, Llorens DPP. Reverse Geometry Hybrid Contact Lens Fitting in a Case of Donor-Host Misalignment after Keratoplasty. Int J Kerat Ect Cor Dis 2013;2(2):69-72.

Saad A, Gatinel D. Retrospective Testing of the Score for the Detection of Ectasia Susceptibility: A Case Report of Ectasia 7 Years after LASIK. Int J Kerat Ect Cor Dis 2013;2(2):73-78.

To report a case of post-LASIK corneal ectasia due to a thick flap, while the contralateral eye did not develop ectasia after an incomplete deep flap cut, followed by a thinner flap LASIK procedure.

Case report

This 45 years old female patient had bilateral myopic LASIK in 1999. Preoperative anterior curvature map was regular with no signs of keratoconus. Central keratometry was 42.88 × 44.70 @ 163 in OD and 43.43 × 45.24 @ 175 in OS. Ultrasound central corneal thickness was 586 μm and 619 μm in the right eye and left eye, respectively. Corneal OCT identified a deep meniscus-shaped LASIK flap, with a central thickness of a 392 μm in the right eye, and an incomplete deep peripheral cut in the left eye with a thinner meniscus-shaped LASIK flap.

Unilateral ectasia after LASIK may occur due to a thick flap which leads to biomechanical failure of the cornea.

Valbon BF, Ambrosio R Jr, Glicéria J, Santos R, Luz A, Alves MR. Unilateral Corneal Ectasia after Bilateral LASIK: The Thick Flap Counts. Int J Kerat Ect Cor Dis 2013;2(2):79-83.

To report a case of keratoconus that progressed during pregnancy without any accompanying disease.

A case report.

A patient with keratoconus that worsened during pregnancy demonstrates that pregnancy can be a previously unrecognized risk factor for progression of keratoconus.

To our knowledge, this is the first case reported in Brazil and the third paper in the world showing pregnancyinduced keratoconus progression in a patient with no accompanying disease.

Glicéria J, Valbon BF, Santos RT, Ambrósio R Jr. Pregnancy-induced Progression of Keratoconus in a 37-Year-Old Patient. Int J Kerat Ect Cor Dis 2013;2(2):84-88.

Nuñez MX, Blanco C. Intacs 210° in Post-lasik Ectasia: Follow-up of Clinical and Biomechanical Changes. Int J Kerat Ect Cor Dis 2013;2(2):89-91.

Elahi S, Rahimian O, Touboul D, Smadja D. Does the Combination of Intracorneal Ring Segments and Photorefractive Keratectomy have a Synergistic Effect on Keratoconus Progression?. Int J Kerat Ect Cor Dis 2013;2(2):92-94.