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Late intracorneal ring segment extrusion in atopic keratoconjunctivitis patients

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Session Details

Session Title: Presented Poster Session: Refractive Surgery Complications

Session Date/Time: Monday 07/09/2015 | 09:30-11:00

Paper Time: 09:40

Venue: Poster Village: Pod 3

First Author: : L.Martinez Perez SPAIN

Co Author(s): :    A. Estevez Colmenero   A. Treus Suarez   J. Etcheverry Saavedra   M. Tourino Peralba   M. Rodriguez Ares  

Abstract Details

Purpose:

Keratoconus is an ectatic corneal disorder with a progressive thinning that causes irregular astigmatism and decreased visual acuity. Intracorneal rings segments (ICRS) has been widely used in the treatment of corneal ectasias. Atopic keratoconjunctivitis (AKC) is a non-infectious inflamatory and chronic condition of the ocular surface. It is associated with atopic dermatitis, characterized by recurring episodes of dry, itchy, redness and easily irritated skin. AKC has been associated with keratoconus ectasia. The main objetive is to report the the risk of a late extrusion segment intracorneal in patients with diagnosis of keratoconus and AKC after ICRS implantation.

Setting:

Cornea and Ocular Surface Unit, Department of Ophthalmology. Complejo Hospitalario Universitario de Santiago de Compostela, Spain.

Methods:

A retrospective study of 115 eyes with diagnosis of keratoconus and ICRS implantation to manage corneal irregularity were performed between January 2009 to December 2014. Inclusion criteria were contact lens intolerance prior to surgery, stage I-III by Amsler-Krumeich classification and no central opacity. KeraRing segments (Mediphacos, Belo Horizonte, Brazil) were implanted in all patients and the minimum follow-up was 4 months. A complete ophthalmic examination , AKC diagnosis, surgical technic and presence of late explantation (≥ 3 months postsurgery) were analized. Statistical analysis was performed with SPSS 20.0 software for Mac (SPSS , Inc , Chigago , Illinois, USA )

Results:

A total of 115 eyes with ICRS implantation were evaluated. The mean age was 33,57 ± 9,28 years (Range: 17-56). Nine cases (7,8%) were diagnosticated of AKC. Late explantation rate in AKC-group was 33,3 % (3 eyes) and no-AKC group was 8.49% ( 9 eyes) . It has been found significant statistical differences between both groups. (p= 0,019 Pearson's Chi-square Test) Time between surgery and extrusion in the AKC-group was 264,67 ± 169,35, less than in the no-AKC group (463 ,67 ± 235,91) , although the change did not reach statistical significance. (p = 0,175, Mann-Whitney U test).

Conclusions:

Clinical trials have shown safety, efficacy and predictability of ICRS in treatment of keratoconus. The presence of atopy, allergy , eye rubbing or use of contact lenses are common findings in ICRS extrusion. It had been proposed that the chronic foreing body reaction created by the ICRS may facilitate an inflamatory response in the epithelium in AKC patients. In our case series, late extrusion segments are more common in patients with AKC , finding signficative differences. There is also a tendency for earlier extrusion segments in AKC patients. However, we need randomized studies with more patients to confirm these results.

Financial Interest:

NONE

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