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Intrastromal corneal rings in one eye versus penetrating keratoplasty in the other eye for the treatment of advanced keratoconus

Poster Details

First Author: A.Barbara JERSEY

Co Author(s):    R. Barbara              

Abstract Details



Purpose:

To present the results of intrastromal corneal rings in one eye versus penetrating keratoplasty in the other eye for the treatment of advanced keratoconus

Setting:

Hadassah Optimal , the Refractive Surgery Unit of Hadassah Hospital , Haifa ,Israel

Methods:

This is a retrospective study on eight patients who underwent penetrating keratoplasty (PKP) in one eye because of advanced keratoconus, In the second eye they underwent in our medical center ISCR implantation , Intacs in four eyes, Ferrara Rings in three eyes and Intacs SK in one eye , the ISCR were implanted using the manual technique , the incision was done at the steep axis , in two eyes the keratoconus was associated with superficial stromal scar , in one of these two eyes photorefractive keratectomy (PRK) was performed , in three eyes collagen corneal cross-linking (CXL) was performed immediately after the implantation of Intacs , in two eyes CXL was performed few months before ISCR Implantation (one eye with Intacs and one eye with 90 degrees Ferrara Rings ) , in one eye CXL was performed five years after Ferrara Rings implantation because of deterioration of visual acuity (VA). The final uncorrected and best spectacle corrected visual acuity (UCVA and BSCVA ) , Keratometry and refraction will be reported . In three of the PKP eyes we performed PRK to reduce the anisometropia other two eyes in this group are candidates for PRK.

Results:

The mean follow up is 3.58 years (SD +-3.36) in the ISCR group and 8.56 years (SD+-3.86) in the PKP group .The mean UCVA(expressed in decimals), BSCVA , sphere , cylinder and average keratometry in the ISCR group are respectively: 0.51 (SD+-0.31), 0.71 (SD+-0.18),-0.28(SD+-1.5) ,-2.28(SD+-2.2) and 48.14(SD+-4.53) , The mean UCVA , BSCVA , sphere , cylinder and average keratometry in the PKP group are respectively 0.24(SD+-0.26),0.6(SD+-0.17), -2.3(SD+-3.25)-5.0(SD+-3.28)and 45.54(SD+-2.67) . The data show better results in terms of UCVA , BSCVA , myopia and astigmatism in the ISCR versus the PKP group , the keratometry values are higher than in the PKP group . Three eyes in the PKP group underwent PRK in our medical center because of anisometropia , improved in terms of UCVA and the refractive error was corrected , in one of these eyes Ferrara rings were implanted in the graft to reduce the astigmatism , other two eyes in the PKP group are candidates for PRK because of anisometropia. The anisometropia in the PKP group highlights the superiority of the ISCR versus PKP in the treatment of Keratoconus ,moreover the patients in this group are more satisfied from ISCR than from the PKP.

Conclusions:

ISCR combined or not with CXL yielded at least similar if not better results in terms of UCVA and BSCVA with less refractive errors in the ISCR group versus the PKP group , the ISCR group needed les refractive procedures (PRK )versus the PKP group . ISCR in combination with or without CXL should be offered to patients suffering from keratoconus before PKP unless the cornea is heavily scared , ISCR is an out patient surgery done with topical anesthesia ,PKP is a major surgery needing a long period of rehabilitation , deep lamellar keratoplasty(DALK) yields similar results to PKP in term of VA and astigmatism. ISCR are good alternative to PKP , early detection of keratoconus by screening at school and treatment with CXL may stop the keratoconus from deterioration to advanced stages with scarring and may spare the patients the need for PKP or DALK FINANCIAL INTEREST: NONE

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