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Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications

PURPOSE: To examine the clinical outcomes, predictors of visual improvement and complications of continuous intracorneal ring (ICCR) implantation in patients with keratoconus and confirmed contact-lens intolerance (CLI). METHODS: This nonrandomized, multi-centric, retrospective cohort study examined...

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Autores principales: Thiwa, David, Linke, Stephan Johannes, Daxer, Albert, Steinberg, Johannes
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9491368/
https://www.ncbi.nlm.nih.gov/pubmed/36160729
http://dx.doi.org/10.2147/OPTH.S375569
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author Thiwa, David
Linke, Stephan Johannes
Daxer, Albert
Steinberg, Johannes
author_facet Thiwa, David
Linke, Stephan Johannes
Daxer, Albert
Steinberg, Johannes
author_sort Thiwa, David
collection PubMed
description PURPOSE: To examine the clinical outcomes, predictors of visual improvement and complications of continuous intracorneal ring (ICCR) implantation in patients with keratoconus and confirmed contact-lens intolerance (CLI). METHODS: This nonrandomized, multi-centric, retrospective cohort study examined visual, keratometric and clinical outcomes evaluated after a minimum follow-up of 2 months. Among the inclusion criteria for the standard treatment group (STG) were corrected distance visual acuity (CDVA) <20/25 Snellen, no central corneal scars, minimum corneal thickness >350µm, and central mean keratometry reading (meanK) <55 diopters. All other eyes were classified as non-standard treatment group. RESULTS: A total of 118 eyes of 118 patients with aged 32 ± 11 years were included in this study. At a median follow-up of 161 days (interquartile range: 111–372 days) ICCR implantation improved the CDVA from a mean of 0.38 to 0.15 logMAR (p<0.0001). Our correlation analysis showed lower preoperative CDVA to be the single best predictor of CDVA improvement, with eyes of a CDVA of 20/80 or lower improving by 4.3 ± 2.0 lines on average. Eyes with a meanK >55 diopters gained 9.04±4.83 lines in UDVA and 2.86±3.09 lines in CDVA. However, postoperatively these eyes had a CDVA of 0.32±0.21 logMAR which is significantly inferior to the STG outcome (p=0.001372). Fifteen eyes (12.7%) had to undergo a ring exchange procedure because of refractive under- (9 eyes) or overcorrection (6 eyes). Two eyes (1.7%) experienced medical complications. CONCLUSION: This study confirms the inclusion criteria of ICCR implantation in KC eyes with CDVA <20/25 and CLI. Particularly in eyes with a preoperative CDVA <20/80 and a meanK <55 diopters, ICCR implantation should be considered due to its reversibility and low rates of serious complications. The main challenge remains in the low predictability of the magnitude of this improvement in eyes with CDVA >20/30.
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spelling pubmed-94913682022-09-22 Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications Thiwa, David Linke, Stephan Johannes Daxer, Albert Steinberg, Johannes Clin Ophthalmol Original Research PURPOSE: To examine the clinical outcomes, predictors of visual improvement and complications of continuous intracorneal ring (ICCR) implantation in patients with keratoconus and confirmed contact-lens intolerance (CLI). METHODS: This nonrandomized, multi-centric, retrospective cohort study examined visual, keratometric and clinical outcomes evaluated after a minimum follow-up of 2 months. Among the inclusion criteria for the standard treatment group (STG) were corrected distance visual acuity (CDVA) <20/25 Snellen, no central corneal scars, minimum corneal thickness >350µm, and central mean keratometry reading (meanK) <55 diopters. All other eyes were classified as non-standard treatment group. RESULTS: A total of 118 eyes of 118 patients with aged 32 ± 11 years were included in this study. At a median follow-up of 161 days (interquartile range: 111–372 days) ICCR implantation improved the CDVA from a mean of 0.38 to 0.15 logMAR (p<0.0001). Our correlation analysis showed lower preoperative CDVA to be the single best predictor of CDVA improvement, with eyes of a CDVA of 20/80 or lower improving by 4.3 ± 2.0 lines on average. Eyes with a meanK >55 diopters gained 9.04±4.83 lines in UDVA and 2.86±3.09 lines in CDVA. However, postoperatively these eyes had a CDVA of 0.32±0.21 logMAR which is significantly inferior to the STG outcome (p=0.001372). Fifteen eyes (12.7%) had to undergo a ring exchange procedure because of refractive under- (9 eyes) or overcorrection (6 eyes). Two eyes (1.7%) experienced medical complications. CONCLUSION: This study confirms the inclusion criteria of ICCR implantation in KC eyes with CDVA <20/25 and CLI. Particularly in eyes with a preoperative CDVA <20/80 and a meanK <55 diopters, ICCR implantation should be considered due to its reversibility and low rates of serious complications. The main challenge remains in the low predictability of the magnitude of this improvement in eyes with CDVA >20/30. Dove 2022-09-17 /pmc/articles/PMC9491368/ /pubmed/36160729 http://dx.doi.org/10.2147/OPTH.S375569 Text en © 2022 Thiwa et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
spellingShingle Original Research
Thiwa, David
Linke, Stephan Johannes
Daxer, Albert
Steinberg, Johannes
Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications
title Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications
title_full Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications
title_fullStr Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications
title_full_unstemmed Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications
title_short Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications
title_sort continuous intracorneal ring implantation in keratoconus: efficacy, predictive factors, and complications
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9491368/
https://www.ncbi.nlm.nih.gov/pubmed/36160729
http://dx.doi.org/10.2147/OPTH.S375569
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