The article aims to study the individual long-term stability of visual acuity after MyoRing treatment of keratoconus.

This is a retrospective study of the individual visual acuity development for 5 years after MyoRing implantation for keratoconus.

In no single case did uncorrected and corrected distance visual acuity lose one line or more during the first 5 years after MyoRing treatment for keratoconus. Moreover, visual acuity was even further ameliorated in most of the cases until the last follow-up period of 5 years after surgery.

The results indicate that MyoRing placement inside the cornea can achieve both visual rehabilitation and stop of progression of the disease.

Prangl-Grötzl A, Ettl A, Hörantner R, Daxer A. Individual Long-term Visual Stability after MyoRing Treatment of Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):53-56.

Studies on keratoconus treatment with regard to the stage of the disease have not been published. We evaluated patient outcomes over a 5-year period after circular keratotomy (CKT) to treat stage I and II progressive keratoconus.

Clinic Krumeich, Bochum, Germany.

Retrospective clinical study.

We retrospectively evaluated the outcomes of 185 consecutive CKT procedures to treat early, progressing keratoconus. A 7-mm trephine incision, with a depth that was 90% of the thinnest pachymetry value but not less than 400 µm, was made with the guided trephine system concentric to the pupil and sutured with a double running anti-torque suture. Keratometry readings and astigmatism measurements at 1-year postsurgery were compared with values obtained at 3 and 5 years postsurgery. Preoperative values of best-corrected visual acuity with glasses were compared with values obtained at 3 and 5 years postsurgery. Statistical analyses for significance were performed.

Keratometric readings revealed stability at 5 years postsurgery in 84.3% (n= 51) of those eyes for which all values at all time points were available. Likewise, astigmatism values revealed stability in 92.2% of eyes. Best-corrected visual acuity improved significantly from preoperative to 5 years in 73.68% (n = 38). Best-corrected visual acuity did not change in 18.42% (n = 36).

Circular keratotomy halted the progression of early-stage keratoconus for at least 5 years in 84.3% of the eyes studied. The stable keratometric results suggest that CKT treatment should be considered for patients diagnosed early in the progression of this disease.

Krumeich JH, Hirnschall N. Effect of Circular Keratotomy on Progression of Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):57-62.

To identify changes in the expression of genes coding for extracellular matrix (ECM) proteins in patients with noninflammatory corneal disorder keratoconus (KC), patients with corneal scarring, and normal controls.

Total ribonucleic acid extracted from corneal tissue of 13 KC patients, 2 patients with corneal scaring, and 4 normal controls was analyzed using Human Extracellular Matrix & Adhesion Molecules Profiler Polymerase Chain Reaction Array. Statistically significant changes in gene expression were identified using the Data Analysis software.

Comparison of KC and control corneas with thresholds of 1.5 or greater fold change and a p-value of 0.05 or lower revealed 21 differentially expressed genes: 16 genes were downregulated and 5 were upregulated. Among transcripts downregulated in KC patients, we identified thrombospondin 1, disintegrin and metalloproteinase with thrombospondin motif 1, secreted phosphoprotein 1, several collagens, and integrins. We found transforming growth factor beta-induced (TGFBI or BIGH3) gene was the most significantly upregulated transcript.

The development of KC results in deregulation of gene expression of ECM and adhesion molecules.

Downregulation of collagens and upregulation of TGFBI repeatedly identified in KC patients may be used as clinical markers of the disease.

Bykhovskaya Y, Gromova A, Makarenkova HP, Rabinowitz YS. Abnormal Regulation of Extracellular Matrix and Adhesion Molecules in Corneas of Patients with Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):63-70.

In this article, we present the results of eight eyes of patients who underwent combined same-day partial topography-guided surface ablation followed by accelerated collagen cross-linking (CXL) procedure at Care-Vision Laser Centers to achieve stabilization of corneal ectasia and enhance visual rehabilitation in keratoconus.

A retrospective nonrandomized review of 8 eyes of 6 patients who underwent the Athens Protocol for progressive keratoconus. Each patient underwent topography-guided ablation followed by CXL procedure.

Follow-up was done on day 1, day 7, and then at 1, 3, 6, and 12 months.

There was a rapid and significant improvement in uncorrected visual acuity and best-corrected visual acuity in 100% eyes, a reduction of keratometric values, and symmetry between vertical hemimeridians. Topographic evaluation showed a marked improvement in irregularity. There were no signs of keratoconic progression noted in any of the eyes on last follow-up. No adverse events were reported in any patient.

Simultaneous surface ablation + CXL seems to be a promising treatment capable of offering patients functional vision and halting progression of the disorder.

Simultaneous topography-guided custom ablation treatment and photorefractive keratectomy with CXL offers keratoconic patients intolerant to contact lenses both stabilization of the cornea and improved functional vision with spectacles correction.

Karmona L, Sela T, Franco O, Shoshani A, Munzer G, Kaiserman I. Simultaneous Topography-guided Surface Ablation with Collagen Cross-linking for Keratoconus. Int J Kerat Ect Cor Dis 2016;5(2):71-76.

Bikbov M, Surkova V, Usubov E. Acanthamoeba Keratitis: Different Surgical Approaches. Int J Kerat Ect Cor Dis 2016;5(2):77-80.

Ali H, Nanavaty MA. Clinical Dilemmas in the Management of a Monocular Patient with Down's Syndrome, Dementia, Advanced Keratoconus, and a Mature Cataract. Int J Kerat Ect Cor Dis 2016;5(2):81-84.

Barbara A, Barbara R. Late-onset Post-lasik Ectasia with no Apparent Risk Factor except Eye Rubbing: A Case Report and Literature Review. Int J Kerat Ect Cor Dis 2016;5(2):85-91.