Ten-Year Follow-up of Posterior Chamber Phakic Intraocular Lens with Central Port Design in patients with low- and normal-vault.

PURPOSE: To assess the clinical outcomes and postoperative complications of the Implantable Collamer Lens (ICL) with a central port throughout ten years of follow-up in patients with low- and normal-vault. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Retrospective and comparative case series. METHODS: This study included eyes that underwent a V4c ICL implantation with ten years of follow-up. The eyes were divided into two groups according to the vault at one year postoperatively: Vault < 250 µm; and between 250 and 800 µm. Uncorrected (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), vault, complications and secondary surgeries were analysed. RESULTS: 37 and 90 eyes were enrolled in the low- and normal-vault groups. No differences in UDVA, CDVA and refraction were found between groups at ten years of follow-up. No cases developed ICL-induced anterior subcapsular opacity over the follow-up. Two (5.4%) and eight eyes (8.9%) in the low- and normal-vault-groups required ICL exchange. One (2.8%) and two eyes (2.2%) in the low- and normal-low-vault groups required excimer laser to correct residual refractive error. The IOP remained stable throughout the 10-year follow-up. The loss in ECD from the preoperative at the 10-year postoperatively was 3.8% and 4.5% in the low- and normal-vault groups (P=0.4). No pigment dispersion glaucoma or other vision-threatening complications were reported. CONCLUSIONS: This study shows the good long-term outcomes of the V4c ICL, supporting that the central hole provides safety to the procedure and prevents the potential risk associated with the low vault.

Effect of intrastromal corneal ring segments on in vivo corneal biomechanics in keratoconus: 1-year results.

PURPOSE: To evaluate the 1-year effects of the implantation of intrastromal corneal ring segments (ICRS) in keratoconus (KC) on the dynamic corneal response (DCR) parameters obtained with the Corvis. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Prospective, single-center, clinical study. METHODS: Included were patients who underwent ICRS implantation for KC over a period of 1 year. On the day of the surgery and at least 6 months after ICRS implantation, the following measurements were made: corrected distance and uncorrected distance visual acuity, corneal tomography indices with the Pentacam, biomechanically corrected intraocular pressure and the Corvis DCRs (integrated inverse concave radius, deformation amplitude ratio, stiffness parameter at first applanation, stress-strain index [SSI] and the highest concavity radius). RESULTS: 30 eyes were included with a mean follow-up time of 15 months. Statistical analysis showed that ICRS implantation induced significant improvements in corneal biomechanics measurements between preoperative and long-term follow-up as demonstrated by a significant increase in SSI (P = .003). To confirm that this difference was actually induced due to a stiffening between early postoperative (previously published) and long-term an additional t-test was done between month 1 and late follow-up which confirmed a significant stiffening in the value of SSI (P = .01). CONCLUSIONS: Patients implanted with ICRS alone for KC showed a significantly stiffer response due to increased structural support compared with preoperative values and 1 month postoperative.

Clinical and Aberrometric Outcomes of a New Implantable Collamer Lens for Myopia and Presbyopia Correction in Phakic Patients.

PURPOSE: To assess the clinical and aberrometric outcomes of a new Implantable Collamer Lens (EVO Viva ICL; STAAR Surgical) to correct moderate to high myopia and presbyopia. METHODS: The study included 80 eyes of 40 patients who had bilateral EVO Viva ICL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, presbyopic add power, binocular through-focus visual acuity, total ocular spherical aberration (SA), coma aberration, and root mean square of ocular higher order aberrations (RMS HOAs) (i-Trace Aberrometer; Tracey Technologies) for a 4.5-mm pupil size were evaluated. RESULTS: The mean binocular postoperative UDVA and CDVA were 0.09 ± 0.19 and 0.02 ± 0.03 logMAR, respectively. The postoperative spherical equivalent was -0.61 ± 0.54 diopters (D). The presbyopic add power reduced from +1.31 ± 0.74 D preoperatively to +0.44 ± 0.58 D after surgery (P < .0001). The mean visual acuity was 0.1 logMAR or better (20/25 or better) across the vergence range from +0.50 to -1.50 D, better than 0.2 logMAR (20/32 or better) up to the vergence of -2.00 D, and remained better than 0.3 logMAR (20/40 or better) up to the vergence of -2.50 D. The total ocular aberrations induced by EVO Viva ICL were -0.34 ± 0.09 µm of SA, 0.24 ± 0.18 µm of coma, and 0.26 ± 0.12 µm of RMS HOAs. CONCLUSIONS: The outcomes support that the new ICL might be a good alternative for myopia and presbyopia correction in patients aged between 45 and 55 years. Further studies are needed to evaluate the threshold lens misalignment from which the patient´s visual quality would be affected. [J Refract Surg. 2023;39(9):589-596.].

Intrastromal Corneal Ring Segments Implantation After Deep Anterior Lamellar Keratoplasty for Astigmatism Correction: Mid-term and Long-term Follow-up.

PURPOSE: The aim of this study was to assess the long-term outcomes of implanting intrastromal corneal ring segments (ICRSs) using a femtosecond laser for correcting astigmatism in patients who had previous deep anterior lamellar keratoplasty (DALK) throughout a 5-year follow-up period. METHODS: This retrospective study included 40 eyes of 40 patients with previous DALK and astigmatism ≥3.00 D who underwent Ferrara-type ICRS implantation. The manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity (logMAR), and corneal topography were recorded preoperatively and at 6, 12, 36, and 60 months postoperatively. RESULTS: The mean UDVA (logMAR scale) improved from 1.39 ± 0.55 preoperatively to 0.71 ± 0.37 at 6 months postoperatively ( P < 0.0001). The mean CDVA (logMAR) significantly improved from 0.36 ± 0.17 to 0.22 ± 0.12 at 6 months after surgery ( P < 0.0001). Both UDVA and CDVA remained unchanged throughout the follow-up ( P = 0.09). Postoperatively, no eyes lost lines of CDVA compared to preoperatively, and around 80% of the eyes gained lines of CDVA. The safety index remained stable at a value of 1.4 throughout the follow-up. The refractive cylinder decreased from -6.86 ± 2.62 D preoperatively to -2.33 ± 1.09D at 6 months postoperatively ( P < 0.0001), and subsequently, it was stable over the postoperative period ( P = 0.2). The maximum and minimum keratometry measurements significantly decreased after surgery and remained stable over the postoperative follow-up period ( P > 0.07). CONCLUSIONS: This study shows the long-term viability of Ferrara-type ICRS implantation using a femtosecond laser as a surgical alternative for astigmatism correction in post-DALK eyes.

Modified Deep Anterior Lamellar Keratoplasty Technique to Rescue Failed Penetrating Keratoplasty.

Purpose: To describe a modified deep anterior lamellar keratoplasty (DALK) technique to rescue failed penetrating keratoplasty (PK) grafts and report its results. Patients and Methods: Retrospective, case-series analysis of patients who underwent modified DALK to rescue failed corneal grafts after PK was included. Every patient had corneal graft failure (GF) diagnosis due to anterior corneal (epithelium, Bowman's, and stroma layers) or refraction disorders uncorrectable with conservative management. The main objective of the surgery and primary outcome of the study was the improvement of corrected distance visual acuity (CDVA). The study's secondary outcome was the frequency of intra- and postoperative complications. Results: This series included four eyes from three patients with a mean age of 57.7 years (range: 51-63 years). Mean follow-up of patients was thirteen months (range: 12-15 months). During follow-up, continuous improvement of corneal transparency and CDVA was observed in every patient. The only intraoperative complication reported was a peripheric DM microperforations of previous graft-host junction in two eyes. No signs of double anterior chamber, endothelial failure, GF, glaucoma, or other side effects were reported. Conclusion: Our results suggest that modified DALK in patients with GF after PK, preserving a healthy endothelium, is surgically feasible. However, further studies are needed to compare this procedure to PK and other DALK technique variations.

Three-year follow-up of posterior chamber phakic intraocular lens with a central port design after deep anterior lamellar keratoplasty.

BACKGROUND: To evaluate clinical outcomes of the Visian implantable collamer lens (ICL) with a central port to correct myopia and astigmatism after deep anterior lamellar keratoplasty (DALK) for keratoconus throughout 3 years of follow-up. METHODS: This study included 20 eyes of 20 patients that underwent V4c ICL (13 eyes with a spherical ICL and 7 eyes with a toric ICL) implantation after DALK. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD), and vault were analyzed. RESULTS: The mean UDVA improved from the preoperative 1.18 ± 0.33 logMAR to 0.25 ± 0.14 logMAR at 6 months after surgery (P < 0.0001) and remained unchanged throughout the whole follow-up (P = 0.4). All eyes gained lines of CDVA compared to preoperative values. At the last follow-up visit, all eyes achieved CDVA of 0.2 logMAR or better and 13 eyes (65%) 0.1 logMAR or better. At 6 months post-surgery, all eyes (100%) had a spherical equivalent within ± 1.50 D, and 19 (95%) within ± 1.00 D. The mean manifest spherical equivalent was stable over the postoperative follow-up (P = 0.25). No significant increase in IOP occurred in any case throughout the 3 years of follow-up. The loss in ECD from the preoperative baseline at the last follow-up visit was 2.27%. CONCLUSIONS: The clinical outcomes suggest that the V4c ICL implantation for correction of myopia and regular astigmatism in post-DALK eyes was satisfactory in terms of effectiveness, safety, and stability during 3 years of follow-up.

Femto-LASIK after Deep Anterior Lamellar Keratoplasty to Correct Residual Astigmatism: A Long-Term Case Series Study.

Purpose: To evaluate the long-term outcomes of femtosecond laser-assisted in situ keratomileusis (Femto-LASIK) to correct residual astigmatism after deep anterior lamellar keratoplasty (DALK). Methods: This retrospective case series study included 10 eyes that underwent Femto-LASIK after a DALK. The refractive error, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, thinnest corneal thickness (TCT), and central corneal thickness (CCT) were registered. The postoperative follow-up ranged between 36 and 60 months. Results: All surgeries were uneventful, with no intra- or postoperative complications. The mean UDVA (Snellen scale) rose from 0.13 ± 0.05 to 0.47 ± 0.15 six months after Femto-LASIK (p < 0.001). All cases experienced a significant improvement in UDVA. None of the eyes lost lines of CDVA, and seven eyes (70%) improved the CDVA compared to preoperative values. The refractive cylinder changed from a preoperative value of −3.88 ± 1.00 D to −0.93 ± 0.39 six months after Femto-LASIK (p < 0.0001). In eight eyes (80%), the UDVA and refractive outcomes remained stable at postoperative follow-up visits. In contrast, one eye experienced a refractive regression over the follow-up. TCT and CCT were stable at the different postoperative follow-up visits. Conclusions: Our findings suggest that Femto-LASIK might safely and effectively corrects residual astigmatism after DALK. Despite these encouraging results, further long-term studies, including a larger number of cases, are required to confirm the safety of the procedure. The refractive stability in eyes with prior RK might be lower than for other DALK indications.

The Effect of Intracorneal Ring Segments Implantation for Keratoconus on In Vivo Corneal Biomechanics Assessed With the Corvis ST.

PURPOSE: To evaluate the effect of the implantation of intracorneal ring segments (ICRS) in keratoconus on the dynamic corneal response (DCR) parameters obtained with the Corvis ST (Oculus Optikgeräte GmbH). METHODS: This prospective clinical study included patients who underwent ICRS implantation for keratoconus over a period of 1 year. On the day of the surgery and at least 1 month after ICRS implantation, the following measurements were made: corrected and uncorrected distance visual acuity, corneal tomography indices with the Pentacam (Oculus Optikgeräte GmbH), biomechanically corrected intraocular pressure (bIOP), Corvis ST DCR parameters, integrated inverse concave radius (1/R), deformation amplitude ratio (DA ratio), stiffness parameter at first applanation (SP-A1), stress-strain index (SSI), and highest concavity radius (HRC). RESULTS: Fifty-one eyes of 40 patients were included with a median follow-up time of 3 months (interquartile ratio [IQR]: 2 to 6 months). Statistical analysis showed that ICRS implantation did not affect corneal biomechanical measurements evaluated with the Corvis ST, which was demonstrated by non-significant changes in the SP-A1 (P = .637), 1/R (P = .647), HRC (P = .177), DA ratio (P = .735), and SSI (P = .501). Additionally, the results showed that bIOP measurements were not significantly affected by ICRS implantation (P = .113). CONCLUSIONS: ICRS implantation does not affect corneal biomechanical measurements in early follow-up. [J Refract Surg. 2022;38(4):264-269.].

A New Pre-descemetic Corneal Ring (Neoring) in Deep Anterior Lamellar Keratoplasty for Moderate-Advanced Keratoconus: A Pilot 2-Year Long-Term Follow-Up Study.

Purpose: To assess the outcomes of implanting a new polymethylmethacrylate (PMMA) ring (Neoring; AJL Ophthalmic) in pre-descemet deep anterior lamellar keratoplasty (PD-DALK) procedure for moderate-advanced keratoconus. Methods: This prospective study included 10 eyes of 10 patients with moderate-advanced keratoconus who underwent PD-DALK with Neoring implantation. Neoring was implanted in a pre-descemetic pocket. The post-operative examination included refraction, corrected distance visual acuity (CDVA), corneal tomography, and endothelial cell density (ECD). The root mean squares (RMSs) for coma-like aberrations and spherical aberration were evaluated for a pupil size of 4.5 mm. The junctional graft (Tg) and host (Th) thicknesses were measured. The post-operative follow-up was 24 months. Results: Post-operative CDVA was 0.82 ± 0.14 (decimal scale), 100% of the eyes achieved a CDVA of 0.7 (decimal scale). The refractive cylinder was -2.86 ± 1.65 2-years after surgery. No eyes had a post-operative refractive cylinder ≥5.00 D and in five eyes (50%), it was ≤2.50 D. At the last visit, the mean keratometry was 45.64 ± 1.96 D, the RMS for coma-like aberrations was 0.30 ± 0.15 µm and spherical aberration was 0.22 ± 0.09. The mean ECD remains without changes over the follow-up (P = 0.07). At the last visit, Tg and Th were 679.9 ± 39.0 and 634.8 ± 41.2 µm, respectively. The thickness of the complex (host-Neoring) was 740.6 ± 35.6 µm. In all cases, this thickness was thicker than Tg. Conclusion: The results of this study suggest that PD-DALK along Neoring implantation is a viable, effective, and safe option to optimize the post-operative results for moderate-severe keratoconus.

Seven-year follow-up of posterior chamber phakic intraocular lens with central port design.

BACKGROUND: To assess the clinical outcomes of the Visian Implantable Collamer Lens (ICL) with a central port throughout 7 years of follow-up. METHODS: Eighty-four eyes of 52 patients were evaluated over a follow-up period of 7 years after V4c ICL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD) and vault were analysed. RESULTS: The mean postoperative UDVA (logMAR) was 0.04 ± 0.11, 0.13 ± 0.19 and 0.17 ± 0.23 at 1-, 5- and 7-years, respectively (P < 0.0001). The mean CDVA (logMAR) remains unchanged throughout a 7-year follow-up period (0.02 ± 0.08 and 0.02 ± 0.08, at 5- and 7-years, respectively, P = 0.2). At all follow-up visits, more than 95% of the eyes achieved a CDVA of 20/25 or better and more than 85% a CDVA of 20/20. At the end of the follow-up (7 years), no eye lost more lines of CDVA, 56 eyes (66.7%) and 28 eyes (33.3%) gained lines of CDVA. At 7-years, the spherical equivalent was - 0.62 ± 0.62 D. No significant increase in IOP (> 20 mmHg or an increase higher than 5 mmHg) occurred in any case throughout the 7-year of follow-up. The loss in ECD from the preoperative baseline at the last follow-up visit was 2.6%. No intraoperative or postoperative complications or adverse events occurred during the follow-up period. CONCLUSIONS: The outcomes of this study show the long-term viability of the V4c ICL implantation as a surgical option for the correction of myopia.

Intrastromal corneal ring segment implantation in paracentral keratoconus with perpendicular topographic astigmatism and comatic axis.

PURPOSE: To evaluate the outcomes of implanting intrastromal corneal ring segment (ICRS) using two different strategies in a specific paracentral keratoconus phenotype. METHODS: Eighty-nine eyes with paracentral keratoconus with perpendicular topographic astigmatism and comatic axes were evaluated before and after implanting a 150° arc-length ICRS. Patients were divided into two groups according to the axis where the ICRS was implanted: Group I: comatic axis and Group II: flat topographic axis. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refractive errors, and root mean square (RMS) for coma-like aberration were recorded. The postoperative follow-up was 1 year. RESULTS: Mean UDVA (logMAR) changed from 0.49 ± 0.37 preoperatively to 0.30 ± 0.32 6 months afterwards (p < 0.001) in the group I and from 0.53 ± 0.34 to 0.37 ± 0.35 (p < 0.001), in the group II. Mean CDVA in group I changed from 0.11 ± 0.18 preoperatively to 0.06 ± 0.14 6 months after surgery (p < 0.001). In group II the improvement did not reach statistical significance (from 0.09 ± 0.10 to 0.07 ± 0.09; p = 0.06). No eyes lost lines of CDVA in group I. Eight eyes (15.7%) lost lines of CDVA in group II. The spherical equivalent decreased after surgery in both groups (p < 0.001). The RMS for corneal coma-like aberration only decreased in the group I (p < 0.001). CONCLUSION: Both strategies provided safe and effective visual and refractive outcomes in the specific keratoconus phenotype analyzed. The orthopedic strategy provided better visual outcomes than the refractive one.

Posterior chamber phakic intraocular lens with central-port design in 45- to 55-year-old patients: 1-year follow-up.

PURPOSE: To assess the efficacy, safety, and predictability of the Visian implantable collamer lens with a central port in patients aged between 45 and 55 years. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Retrospective case series. METHODS: Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events over a 1-year period were evaluated retrospectively. RESULTS: A total of 87 eyes (49 patients) were evaluated. The mean postoperative UDVA and CDVA were 0.82 ± 0.24 and 0.93 ± 0.12, respectively. Seventy-eight eyes (approximately 90%) achieved a CDVA of 20/25 or greater. No eye lost 1 or more lines, 53 eyes (60.92%) did not change, 15 eyes (17.24%) gained 1 line, and 19 eyes (21.84%) gained 2 lines or more of CDVA. The efficacy and safety indexes were 0.95 and 1.08, respectively. Seventy-eight eyes (89.65%) were within ±0.50 diopter (D) of the desired sphere refraction, and all eyes (100%) were within ±1.00 D. Fifty eyes (57.7%) showed a spherical equivalent within ±0.13 D. The mean postoperative IOP was 13.58 ± 1.79 mm Hg, and no significant rise (>18 mm Hg) occurred during the follow-up. The largest proportion of eyes (35.63%) reported a reduction in IOP by 1 to 2 mm Hg. Postoperative mean ECD was 2574 ± 362 cells/mm2 (0.41% loss from the preoperative baseline). The mean postoperative vault was 398 ± 187 µm, being the most prevalent range from 201 to 300 µm (22.89% of eyes). No adverse events were reported during the study. CONCLUSIONS: The outcomes reported in this study support the use of this lens in older patients.

Three-year follow-up of intrastromal corneal ring segment implantation in central keratoconus with regular astigmatism: 'Bow-tie' shape.

PURPOSE: To assess the outcomes of implanting Ferrara-type intrastromal corneal ring segments in central 'bow-tie'-shaped keratoconus over 3 years of follow-up. METHODS: A total of 20 eyes with central 'bow-tie'-shaped keratoconus were evaluated before and after implanting Ferrara-type intrastromal corneal ring segments (AJL Ophthalmic, Spain). LogMAR uncorrected distance visual acuity and best corrected distance visual acuity and residual refractive errors analysed using vector analysis were recorded preoperatively, at 6 months, 1 year, and 3 years postoperatively. RESULTS: The mean uncorrected distance visual acuity (LogMAR scale) rose from a preoperative 0.75 ± 0.28 to a 6-month postoperative 0.38 ± 0.28 (p < 0.0001). The corrected distance visual acuity, in turn, improved from 0.07 ± 0.06 to 0.05 ± 0.06 (p = 0.0008). Both the uncorrected distance visual acuity and corrected distance visual acuity were stable over the postoperative period in both groups (p > 0.05). None of the eyes lost uncorrected distance visual acuity and corrected distance visual acuity lines over the postoperative follow-up period. The spherical equivalent and the refractive cylinder declined steeply after intrastromal corneal ring segments implantation (p < 0.0001). Both the spherical equivalent and refractive cylinder were stable over the postoperative period. None of the eyes had an increase in maximum or minimum keratometry greater than 0.75D over the postoperative period. CONCLUSION: The planning for intrastromal corneal ring segments insertion proposed in this study reduces the spherical equivalent and refractive cylinder in this type of keratoconus, while improving post-surgery uncorrected distance visual acuity and corrected distance visual acuity. These results remain stable over 3 years of follow-up. Therefore, this procedure could be considered as an effective therapeutic alternative in patients affected by this type of keratoconus.

FemtoLASIK After Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To evaluate the efficacy and safety of femtosecond laser-assisted in situ keratomileusis (FemtoLASIK) to correct the residual refractive error after Descemet membrane endothelial keratoplasty (DMEK). METHODS: This case series study included 7 eyes that underwent FemtoLASIK after a DMEK surgery. The refractive error, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography (Sirius, CSO, Italy), and anterior segment optical coherence tomography (Visante, Carl Zeiss-Meditec AG, Jena, Germany) were registered at each postoperative follow-up visit. RESULTS: All surgeries were uneventful, with no intraoperative or postoperative complications. The follow-up time after DMEK (before FemtoLASIK surgery) ranged from 18 to 36 months. The post-FemtoLASIK follow-up period ranged from 12 to 60 months. All cases experienced a significant improvement in UDVA after FemtoLASIK, all of them reaching a postoperative UDVA value ≥20/32. None of the eyes lost lines of CDVA, and 1 case showed a gain of lines of CDVA. In all cases, the refractive error, UDVA, and CDVA values remained stable at their respective postoperative follow-up visits. Furthermore, all topographic and pachymetric parameters were stable at the different postoperative follow-up visits. CONCLUSIONS: Our findings suggest that the residual refractive error after DMEK surgery can be safely and effectively treated with FemtoLASIK.

Long-Term Follow-up of Intrastromal Corneal Ring Segment Implantation in Pediatric Keratoconus.

PURPOSE: To evaluate efficacy, safety, and stability of Ferrara-type intrastromal corneal ring segment (ICRS) implantation for visual rehabilitation in pediatric patients with keratoconus. METHODS: This study included patients with keratoconus aged 18 years or younger who had received Ferrara-type ICRS implantation. The uncorrected and corrected distance visual acuities, residual refractive errors, and root mean square for coma-like aberration were recorded preoperatively and at 6 months, 1, 3, and 5 years postoperatively. RESULTS: One hundred eighteen eyes of 88 patients (mean age 16.1 ± 1.89; range 10-18) were studied. All patients were examined at a 6-month follow-up after ICRS implantation, and at the 12-, 36-, and 60-month follow-ups, 97, 71, and 23 eyes were evaluated, respectively. Mean uncorrected distance visual acuity (logarithm of minimum angle of resolution) changed from 0.67 ± 0.37 preoperatively to 0.37 ± 0.30, 6 months after ICRS implantation (P < 0.0001). Mean corrected distance visual acuity increased in turn from 0.19 ± 0.15 to 0.10 ± 0.12 (P < 0.0001). The percentage of eyes with a refractive cylinder ≤2.00 D increased from 30.5% before surgery to 70.3% 6 months later, and the root mean square for corneal coma-like aberration showed a statistically significant decrease (P < 0.001). At the follow-up visits, refractive and visual values remained stable compared with those of the 6-month visit. CONCLUSIONS: Our long-term results suggest that Ferrara-type ICRS implantation is a safe, effective, and stable procedure for restoring vision in pediatric patients with keratoconus.

Implantable Collamer Lens® for Management of Pseudophakic Ametropia in Eyes With a Spectrum of Previous Corneal Surgery.

PURPOSE: To assess the visual outcomes, predictability, and safety of the Implantable Collamer Lens (ICL) (STAAR Surgical, Inc., Monrovia, CA) for the management of residual pseudophakic refractive error. METHODS: Forty-nine pseudophakic eyes of 40 patients in which myopic, hyperopic, or toric ICLs were implanted were retrospectively analyzed. Twenty-nine eyes had been implanted with a monofocal intraocular lens (IOL) and 20 eyes had a multifocal IOL. All IOLs were implanted in the capsular bag. Of the 49 eyes included, 6 had residual refractive error after phacoemulsification without corneal pathology or surgical alteration (virgin cornea group), 12 had LASIK or photorefractive keratectomy (PRK) (excimer laser group), 8 had radial keratotomy, 5 had intrastromal corneal ring segments (ICRS) implantation, 11 had penetrating keratoplasty, and 7 had deep anterior lamellar keratoplasty (DALK). Uncorrected and corrected (CDVA) distance visual acuity and manifest refraction were evaluated. RESULTS: The efficacy/safety indices were 0.92/1.10, 0.98/1.13, 1.04/1.11, 0.90/1.13, 0.79/1.17, and 0.71/1.23 for the virgin cornea, excimer laser, radial keratotomy, ICRS, penetrating keratoplasty, and DALK groups, respectively. No eye lost one or more lines of CDVA. The virgin cornea, excimer laser, and radial keratotomy groups showed better predictability and accuracy, with 96.2% spherical equivalent within ±1.00 diopters (D). The ICRS, penetrating keratoplasty, and DALK groups demonstrated approximately 50% spherical equivalent within ±1.00 D. There were no intraoperative or postoperative complications. CONCLUSIONS: Good refractive outcomes and a strong safety record support the use of the ICL for the correction of residual refractive error in pseudophakic eyes with previous corneal surgery. [J Refract Surg. 2018;34(10):654-663.].

Implantable collamer lens with central hole: 3-year follow-up.

PURPOSE: To evaluate the long-term predictability, stability, safety, and efficacy of the V4c Visian implantable collamer lens (ICL) with central hole to correct myopia. PATIENTS AND METHODS: One hundred and eighty-four eyes of 92 patients were evaluated during 3 years after implantation of the V4c ICL. The refraction, uncorrected distance visual acuity, best-corrected distance visual acuity, IOP, endothelial cell count, vault, and adverse effects were evaluated every 12 months during the whole follow-up. RESULTS: The mean spherical equivalent dropped from -8.30±2.98 D preoperatively to -0.37±0.47 D at 36 months post-surgery, with 91.8% eyes being within ±1.00 D of emmetropia. With respect to the astigmatic components J0 and J45, 98.4% and 99.5% of eyes, respectively, were within ±0.50 D of the desired refraction. At 36 months, 78.8% of eyes had no change in the Snellen lines of best-corrected distance visual acuity, while 8.7% gained one line and 6.5% gained two or more lines; mean safety and efficacy indexes were 1.03 and 0.90, respectively. Mean endothelial cell count was 2,742±340 cells/mm2 before and 2,663±366 cells/mm2 at 36 months post-surgery. Mean IOP reduced from 13.7±1.9 mmHg preoperatively to 12.8±1.7 mmHg at 36 months post-surgery. Mean vault varied from 409±196 µm at 12 months to 349±165 µm at 36 months. CONCLUSION: The visual and refractive outcomes were very good and highly stable throughout the follow-up period, indicating that this ICL model may be predictable, stable, safe, and effective to correct myopia in the long term.

Plasma rich in growth factors membrane as coadjuvant treatment in the surgery of ocular surface disorders.

To evaluate the safety and efficacy of the surgical use of plasma rich in growth factors fibrin membrane (mPRGF) in different ocular surface pathologies.Fifteen patients with different corneal and conjunctival diseases were included in the study. Patients were grouped according to the use of mPRGF as graft (corneal and/or conjunctival) or dressing; they were also grouped according to the surgical subgroup of intervention (persistent corneal ulcer [PCU], keratoplasty, superficial keratectomy, corneal perforation, and pterygium). Best corrected visual acuity, intraocular pressure (IOP), inflammation control time (ICT), mPRGF AT (PRGF membrane absorption time), and the healing time of the epithelial defect (HTED) were evaluated throughout the clinical follow-up time. Safety assessment was also performed reporting all adverse events.mPRGF showed a total closure of the defect in 13 of 15 patients (86.7%) and a partial closure in 2 patients (13.3%). The mean follow-up time was 11.1 ±â€Š4.2 (4.8-22.8) months, the mean ICT was 2.5 ±â€Š1.1 (1.0-4.0) months, the mean mPRGF AT was 12.4 ±â€Š2.0 (10.0-16.0) days, and for the global HTED the mean was 2.9 ±â€Š1.2 (1-4.8) months. Results showed an improvement in BCVA in all patients, with an overall improvement of 2.9 in Vision Lines. The BCVA significantly improved (P < .05) in the groups of corneal graft and dressing. In the PCU subgroup (6 patients), the healing time of epithelial defect was significantly reduced (P < .05) in patients treated only with the mPRGF in comparison to those which mPRGF therapy was associated to the amniotic membrane. The IOP remained stable (P > .05) throughout the clinical follow-up time. No adverse events were reported after mPRGF use.The mPRGF is effective and safe as coadjuvant treatment in surgeries related with ocular surface disorders, being an alternative to the use of amniotic membrane. The mPRGF accelerates tissue regeneration after ocular surface surgery thus minimizing inflammation and fibrosis.

Long-Term Follow-Up of Intrastromal Corneal Ring Segments in Paracentral Keratoconus with Coincident Corneal Keratometric, Comatic, and Refractive Axes: Stability of the Procedure.

PURPOSE: To assess the long-term outcomes of implanting intrastromal corneal ring segments (ICRS) in paracentral keratoconic eyes. METHODS: 58 eyes with paracentral keratoconus with coincident refractive, keratometric, and comatic axes were evaluated. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity and refractive errors were recorded before and at all follow-up visits. The postoperative follow-up was 5 years. Patients were divided into two groups: group I (30 years old or younger) and group II (more than 30 years old). RESULTS: The mean UDVA (logMAR) rose from a preoperative 0.83 ± 0.31 to a five-year postoperative 0.42 ± 0.33 (P < 0.0001). The mean CDVA varied from 0.16 ± 0.17 to 0.11 ± 0.18 (P = 0.0003). Both the UDVA and CDVA were stable over the postoperative period in both groups (P > 0.05). The spherical equivalent and the refractive cylinder declined steeply after ICRS implantation in both groups (P < 0.001), and were stable over the postoperative period (P > 0.05). The keratometric values were also stable over the postoperative follow-up. CONCLUSION: Ferrara-type ICRS implantation in keratoconus that meets the characteristics of the sample under study reduces the refractive error at the same time as it improves postoperative UDVA and CDVA six months after surgery and that these results remain stable over five years of follow-up.

Sequential intrastromal corneal ring segment and monofocal intraocular lens implantation for keratoconus and cataract: Long-term follow-up.

PURPOSE: To evaluate the efficacy, safety, predictability, and stability of sequential Ferrara intrastromal corneal ring segment (ICRS) and intraocular lens (IOL) implantation in patients with keratoconus and cataract. SETTING: Fernández-Vega Ophthalmological Institute, Oviedo, Spain. DESIGN: Retrospective case series. METHODS: This study comprised patients with keratoconus and cataract who had ICRS implantation followed 6 months later by IOL implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities and residual refractive errors, analyzed using vector analysis, were recorded preoperatively, 6 months after ICRS implantation, 6 months after IOL implantation, and 3 years and 5 years thereafter. RESULTS: Seventy eyes of 47 patients were studied. The mean UDVA was 1.08 logMAR ± 0.24 (SD) preoperatively, 0.95 ± 0.31 logMAR 6 months after ICRS implantation (P = .03), and 0.44 ± 0.29 logMAR 6 months after IOL implantation (P < .0001). The mean CDVA changed from 0.35 ± 0.23 logMAR before surgery to 0.28 ± 0.22 logMAR 6 months after ICRS implantation (P < .0001) and to 0.11 ± 0.16 logMAR 6 months after IOL implantation (P < .0001). The UDVA and CDVA were stable over the period after the second procedure (P > .05). The spherical equivalent (SE) and the refractive cylinder declined steeply after IOL implantation (P < .001) and then were stable (P > .05). CONCLUSION: Sequential ICRS and IOL implantation provided good visual and refractive outcomes and was an effective, safe, predictable, and stable procedure for the treatment of patients with keratoconus and cataract.