To report complications after the implantation of Keraring 355° intrastromal corneal ring (ICR; Mediphacos, Belo Horizonte, Brazil) in keratoconic eyes using a Ziemer LDV femto- second laser (Ziemer AG, Switzerland) for channel creation.

Five eyes suffering from keratoconus underwent Keraring 355° insertion using Ziemer LDV for corneal pocket creation. Intraoperative and postoperative complications were recorded.

While intraoperatively there were no complication, postoperatively all cases showed severe side effects.

In this small case series, intracorneal ring (Keraring 355°) implantation using a femtosecond laser for channel creation was related to a number of significant postoperative problems in all cases. The most common complication was corneal melting (postoperatively).

Jadidi K, Mosavi SA, Nejat F, Alishiri A. Complications of Intrastromal Corneal Ring Implantation (Kera- ring 355°) using a Femtosecond Laser for Channel Creation. Int J Kerat Ect Cor Dis 2014;3(2):53-56.

Daxer A. Biomechanics of the Cornea. Int J Kerat Ect Cor Dis 2014;3(2):57-62.

To determine the long-term efficacy and safety of riboflavin/ultraviolet a corneal cross-linking (CXL) to halt the progression of keratoconus.

Thirty-five patients (35 eyes) who had undergone CXL with epithelial removal 5 or more years previously were examined.

At 5 years, mean spherical equivalent (SEQ) increased by 0.78 diopters (D) (p < 0.001), mean simulated K (Sim K) reduced by 0.86D (p < 0.00001), cone apex power (CAP) reduced by 1.1D (p < 0.0002) and root mean square (RMS) (p < 0.0001), coma (p < 0.0001), and secondary astigmatism (p < 0.001) decreased compared to preoperative values. Compared to values at 1 year, mean refractive cylinder reduced by 0.26D (p < 0.05), mean Sim K reduced by 0.46D (p < 0.0005), CAP reduced by 0.81D (p < 0.01), RMS (p < 0.001), coma (p < 0.002) and secondary astigmatism (p < 0.02) reduced and central pachymetry increased (p < 0.05) at 5 years. No treated eyes showed evidence of progression at 5 years. None lost >1 line of CDVA. Eight untreated fellow eyes progressed during the follow-up period and underwent CXL.

Corneal cross-linking is an effective treatment to halt the progression of keratoconus at 5 years, with no sight-threatening complications. Improvements in topographic and wave-front indices present at 1 year continue to improve at 5 years.

O’Brart PSD, Patel P, O’Brart NA. Five Years Follow-up of Riboflavin/Ultraviolet A (370 nm) Corneal Collagen Cross-linking to Halt the Progression of Keratoconus. Int J Kerat Ect Cor Dis 2014;3(2):63-68.

Barbara A, Barbara R. How to improve Visual Acuity after Intrastromal Corneal Ring Segments? Implantation for Keratoconus and Post-LASIK Ectasia. Int J Kerat Ect Cor Dis 2014;3(2):69-75.

Castillo JH, Hanna R, Berkowitz E, Tiosano B. Wavefront Analysis for Keratoconus. Int J Kerat Ect Cor Dis 2014;3(2):76-83.

To report refractive, topographic and safety outcomes of corneal cross-linking (CXL) in patients younger than 18 years of age with progressive keratoconus.

In this retrospective study, we enrolled 31 eyes of 21 children aged 11 to 17 years that underwent corneal riboflavin-ultraviolet A induced CXL due to progressive keratoconus at three different ophthalmology departments in Israel. They were followed for 3 to 48 months (average 23 ± 13.6 months). Evaluated parameters were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction, pachymetry, slit- lamp examination and corneal topography at baseline and at 1,3,6,12,24 and 48 months.

We found a nonsignificant improvement in UCVA and BSCVA with a small reduction of manifest cylinder and no significant change in spherical equivalent or K-values. Following CXL, stability of UCVA and BSCVA at the last follow-up examination was found in 71 and 77% of treated eyes, respectively. No permanent adverse events have been recorded throughout the study period.

In our series, CXL was a safe procedure in the pediatric population. Stabilization of progressive keratoconus was achieved in visual acuity, refractive and topography parameters with no improvement in corneal indices in contrary to adult CXL treatment.

Bakshi E, Barequet IS, Aizenman I, Levinger S, Avni I, Zadok D. Corneal Corss-linking in Patients Younger than 18 Years: Long-term Follow-up in Three Israeli Medical Centers. Int J Kerat Ect Cor Dis 2014;3(2):84-87.

Barbara R, Barbara A. Intrastromal Corneal Ring Segment with and without Collagen Corneal Crosslinking vs Penetrating Keratoplasty for the Treatment of Keratoconus. Int J Kerat Ect Cor Dis 2014;3(2):88-94.

To describe two cases of contact lens-related infectious keratitis with secondary corneal thinning.

Case reports and review of the literature.

The first case is of a 13-year-old girl, contact lens user, admitted for acute corneal infection in her right eye (OD). Seven years after treatment, she presented with corneal thinning and flattening with uncorrected distance visual acuity of 20/30 OD; thinnest value was 363 µm in OD and 513 µm in the left eye (OS). The second case is a 22-year-old male, cosmetic contact lens user, first presented with severe keratitis in OD. One year after treatment, the eye was quiet with moderate corneal opacity; corneal thickness was 228 µm OD and 561 µm OS. Ectasia was identified due to the protrusion and steepening with an irregular curvature pattern. Rigid gas permeable (RGP) contact lens fitting enabled visual acuity of 20/25 OD.

Corneal melt with secondary stromal loss and thinning may lead or not to secondary ectasia. Visual rehabilitation is possible with RGP contact lenses despite corneal opacity. The risk of infectious keratitis among contact lenses users should be considered.

Almeida R, Rodrigues F, Santos M, Siqueira R, Contarini P, Salgado-Borges J, Ambrosio R Jr. Corneal Thinning after Contact Lens-related Infective Keratitis. Int J Kerat Ect Cor Dis 2014;3(2):95-98.