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Refractive surgery of keratoconus: 12 years of experience

Poster Details

First Author: M.Dvali GEORGIA

Co Author(s):    B. Sirbiladze   N. Tsintsadze   N. Jankarashvili              

Abstract Details

Purpose:

To evaluate efficacy and stability of visual, refractive, corneal topographic and aberrometric outcomes using different types of intrastromal corneal implants in eyes with keratoconus aiming to improve functional data together with halting the progression of the disease.

Setting:

Tbilisi State Medical University, Eye Clinic Akhali Mzera; Tbilisi Georgia

Methods:

1583 keratoconic eyes of 921 patients with keratoconus (II-III) were treated with 1 or 2 ISCRS implantation according special nomograms. Pre and post op exam included UDVA, CDVA, manifest refraction, biomicroscopy, fundus evaluation, ultrasound pachymetry, corneal topography and aberrometry on Orbscan. The 3 different models of PMMA intracorneal rings have been used: 1) Ferrara ring (AJL OHTHALMIC, Spain); 2) Keraring (Mediphacos Inc, Brazil); 3) intrastromal rings Dvali Kerabow ) (MORCHER®, Germany) with meniscus shape crosscut and holes in the body for less disturbance of tissue trophic. 1 or 2 segments, options with 90, 120, 160 or 210° arc-length were used.

Results:

Preop: UCVA – 0.12 + 0.07; BCVA – 0.3 + 0.2; K-readers: 53.1 + 3.7 (steep meridian), 46.8 + 3.7 (flat meridian); PBFS – 54.75 + 1.9; SE – 7.2 + 3.5; astigmatism 6.1 + 1.5. Post Op: UCVA – 0.7 + 0.2; BCVA – 0.7 + 0.2; K-readers: 45.9 + 3.7 (steep meridian), 42.8 + 2.7 (flat meridian); PBFS – 51.0 + 2.1; SE – 2.0 + 1.5; astigmatism 2.5 + 0.7. Corneal flattening profile is almost always reproducible independently from the KC shape, the refractive value of flattening is different defend of corneal biomechanics of each cornea.

Conclusions:

ISCRS implantation is a safe and effective therapeutic treatment for patients with mild/moderate progressive keratoconus, to avoid keratoplasty avoiding the greater risks of rejection of other complications. In this way it is not only clinically but a cost effective. It improves all main parameters of corneal topography; which results in increase of UCVA. The reduction in segment diameter effectively controls astigmatism. Segments nearer from pupil margins can induce blur and glares. So compromise between ring effect and visual quality should be found. 4 arc-length options makes ISCRS flexible to achieve the better refractive outcomes.

Financial Disclosure:

NONE

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