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Purpose: To compare the efficacy of implanting a single Keraring segment according to a novel Q‐value‐based nomogram (QN) to that of segment implantation according to the manufacturer's standard nomogram (SN), for keratoconus treatment. Methods: This was a prospective, randomized controlled trial of 104 patients (104 eyes) with Amsler‐Krumeich grade 1 or 2 keratoconus, and type 1 or 2 cone asymmetry determined according to manufacturer's classification. They were randomly distributed into two groups: group A patients (n = 52) underwent Keraring implantation according to the SN, and group B patients (n = 52) underwent implantation of a single (210° arc‐length) Keraring segment according to the QN. Both treatments were combined with accelerated transepithelial cross‐linking, and follow‐up was 6 months. Main outcome measures were preoperative and postoperative visual acuity, subjective refraction and corneal topography. Results: At postoperative month 6, group B exhibited statistically significantly higher values of mean uncorrected distance visual acuity (UDVA), sphere, K2, K‐average, K‐max and Q‐anterior (p = 0.02, 0.01, 0.002, 0.001, 0.0001 and 0.03, respectively) compared to that of group A. However, group A exhibited better refractive cylindrical improvements (p = 0.04). In group A, we documented spontaneous extrusion of one Keraring segment. Conclusion: Single 210° arc‐length segment implantation using our objective QN was more efficacious for keratoconus treatment than using the subjective SN. The nomograms were comparable when the Q‐anterior value was >−1.00; however, the QN was superior to the SN when the Q‐anterior value was ≤−1.00. The QN yielded greater postoperative UDVA and smoother corneal remodelling than did the SN for treatment of grade 1 and 2 keratoconic eyes. [ABSTRACT FROM AUTHOR]

Objectives: To document the difference between complication rate in the early curve of practicing intracorneal stromal rings and after gaining experience. Patients and methods: A retrospective study of 623 eyes of 417 patients with keratoconus who underwent Keraring implantation using femtosecond laser for channel creation. Results: The main outcome measures were reported intraoperative and postoperative complications. The overall complication rate was 12.7% (79 eyes) over the 4 years with 34 eyes in the first year (5.5%) and six eyes in the fourth year (0.96%). Over the 4 years of our practice, intraoperative complications were 7.1% and postoperative complications were 5.6%. Yet, there was a significant difference in intraoperative complications between the first and the fourth year where it was 3.5% and 0.48%, respectively. This also applies to the postoperative complication rate, which decreased from 1.9% to 0.5% in the fourth year. Conclusion: Complications with femtosecond-assisted intracorneal stromal ring procedure can be reduced by experience, making this procedure a safe and effective means of treating kerato-conus. Yet, there are some complications that cannot be avoided such as sterile keratitis. [ABSTRACT FROM AUTHOR]

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Aims: The aim of the study was to evaluate the refractive, topometric and aberrometric changes in corneas with keratoconus treated with femtosecond laser intracorneal ring segment (ICRS) implantation following a proposed modified nomogram. Settings and design: This is a retrospective, consecutive case series. Materials and methods: ICRS implantation using the new proposed nomogram was performed in 10 eyes of seven patients with type 1 and type 2 keratoconus. Corneal tunnels were created using femtosecond laser, and KeraRings were inserted in all eyes. All cases were followed up every 3 months for 6 months using the Pentacam Phoenix system. Statistical analysis: All analyses were performed with SPSS for windows 2007. Results: None of our patients developed complications related to ring placement, such as migration, extrusion or infection. In this limited case series an improvement was seen in uncorrected visual acuity (P ≤ 0.05), best spectacle corrected visual acuity (P ≤ 0.001) and refraction at 6 months (P < 0.001). Keratometric readings improved (P < 0.001), with flattening of the cornea. Corneal aberrations showed significant reduction when analysed by Zernike (P < 0.001) and Fourier analysis (P ≤ 0.001). Corneal asphericity (Q value) also showed improvement (P < 0.05). Conclusion: Femtolaser ICRS implantation using the proposed modified nomogram showed promising results in improving refraction, visual acuity, corneal topography and aberrations in patients with keratoconus. [ABSTRACT FROM AUTHOR]

Background: Keratoconus, the most common primary corneal ectasia, is a bilateral asymmetric corneal degeneration accompanied with local corneal thinning and occurs mostly in the inferior and central part of the cornea, it usually causes high myopia and irregular astigmatism which results in poor quality of vision. Based on disease severity, many treatment modalities exist including glasses and contact lenses for mild to moderate disease, while corneal graft preserved for more advanced disease. In advent of alternative treatments, intrastromal ring implantation have been introduced which improves visual acuity and optical aberrations and also corrects refractive errors and mean keratometric data, anterior segment Optical cohehernce Tomography epithelial mapping is anew modality to assess epithelial thickness. Objective: To investigate epithelial thickness changes in keratoconic patients before and after intracorneal ring segment implantation using AS OCT. Methods: Thirty eyes with early to moderate keratoconus were included in this prospective interventional case series study which has been conducted at patients from Ain shams university hospitals, after the approval of the research ethical committee in the Faculty of Medicine, Ain Shams University between March to October. All cases underwent a Complete ophthalmological examination before surgery. the examination included Visual acuity assessment and Best corrected visual acuity. Slit Lamp Biomicroscopy examination with fundus examination through dilated pupil using D lens & Corneal Topography, Anterior segment Optical cohehernce Tomography Epithelial mapping(- zeiss). Results: we found that epithelial thickness showing statistically significant change comparing pre and post operative epithelial mapping especially in certain areas in the map, area (_),(_) mm. Conclusion: There is increase in epithelium thickness in keratoconic corneas after intracorneal ring segment implantation to compensate for stromal irregularities in patients with keratoconus. [ABSTRACT FROM AUTHOR]

Background: This paper seeks to evaluate the depth and outcomes of MyoRing implantation using two mechanical dissection procedures including: PocketMaker microkeratome in opposition to the Melles hook method.Methods: This retrospective study was carried out on 39 eyes of 38 keratoconus patients (28 male and 10 female) with the mean age of [Formula: see text] years and had undergone MyoRing implantation by the two mentioned methods. The MyoRing was inserted into the corneal pocket which was made manually in 18 eyes (Melles hook group) or with PocketMaker microkeratome in 21 eyes (PocketMaker group). The mean follow up time was [Formula: see text] months with pre-operative and post-operative ophthalmic examination including uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), keratometry readings and central corneal thickness measurement. AS-OCT (Casia, SS-1000, Tomey, Nagoya, Japan) imaging was used to measure MyoRing insertion depth, exactly.Results: Pre-operative and post-operative UCVA (LogMAR) mean change for the PocketMaker and Melles hook groups were recorded at 0.75 ± 0.32 and 0.78 ± 0.33, respectively. Similarly, BCVA (LogMAR) mean change were 0.27 ± 0.22 and 0.23 ± 0.22. Mean keratometry (Kmean) change were 6.06 ± 4.18 and 6.56 ± 3.55 respectively. UCVA change (P = 0.767), BCVA change (P = 0.77) and Kmean change (P = 0.693) showed that there was no statistically significant difference between both groups for any parameter. Depth measurements achieved from AS-OCT images showed that there was no statistically significant difference in pocket depth between two methods of MyoRing implantation (P = 0.413).Conclusions: The results of Myoring implantation outcomes using mechanical dissection via PocketMaker microkeratome as against Melles hook are comparable. [ABSTRACT FROM AUTHOR]