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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., Depto. de Optometría y Visión, Fac. de Óptica y Optometría, TRUE, pub

Carlos Lisa,1,* Ricardo Machado Soares,2,* Luis Fernández-Vega-Cueto,1 Belén Alfonso-Bartolozzi,1 Jose F Alfonso1 1Cornea and Lens Department, Fernández-Vega Ophthalmological Institute, Oviedo, Spain; 2Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Porto, Portugal*These authors contributed equally to this workCorrespondence: Ricardo Machado Soares, department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Rua Conceição Fernandes, S/N, Vila Nova de Gaia, Porto, 4434-502, Portugal, Tel +35 1915045174, Email Ricardo.machado.soares@chvng.min-saude.ptPurpose: 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 mo

Luis Fernández-Vega-Cueto,1 Carlos Lisa,1 José J Esteve-Taboada,2 Robert Montés-Micó,2 José F Alfonso1,3 1Department of Surgery, Fernández-Vega Ophthalmological Institute, Oviedo, Spain; 2Department of Optics and Optometry and Visual Sciences, University of Valencia, Valencia, Spain; 3School of Medicine, University of Oviedo, Oviedo, Spain 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 t