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To evaluate the outcomes of implanting a 150° arc-length intrastromal corneal ring segment (ICRS) using a femtosecond laser in patients with post-LASIK ectasia throughout a 5-year follow-up period.This study enrolled 45 eyes of 45 patients diagnosed with post-LASIK ectasia who underwent a 150° arc-length Ferrara-type ICRS implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, residual refractive errors, and root mean square (RMS) for coma-like aberration were evaluated preoperatively and at 6-, 12-, 36, and 60 months postoperatively.Mean UDVA (logMAR) ameliorated from 0.53 ± 0.33 preoperatively to 0.26 ± 0.24 at 6 months postoperatively (These results suggest that implanting a single 150° arc-length Ferrara-type ICRS is a safe, effective and stable procedure for visual restoration in post-LASIK ectasia. In very few cases, visual and/or refractive instability was experienced throughout the follow-up.

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.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.The mean UDVA (logMAR scale) improved from 1.39 ± 0.55 preoperatively to 0.71 ± 0.37 at 6 months postoperatively (P0.0001). The mean CDVA (logMAR) significantly improved from 0.36 ± 0.17 to 0.22 ± 0.12 at 6 months after surgery (P0.0001). 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 (P0.0001), 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 (P0.07).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.

PURPOSE: To assess the outcomes of implanting a new 300° arc-length intrastromal corneal ring segment (ICRS) in moderate to advanced central hyperprolate keratoconus. METHODS: Forty-two eyes with moderate to advanced central hyperprolate keratoconus were evaluated before and after implanting an inferior 300° ICRS (AJL Ophthalmic). The clinical measurements taken included manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity (logMAR scale), and corneal tomographic analysis (Sirius; Costruzioni Strumenti Oftalmici). Changes in the anterior and posterior corneal surfaces and the root mean square (RMS) for coma-like aberrations for a pupil size of 4.5 mm were evaluated. All examinations were performed before surgery and 6 months after surgery. RESULTS: The mean UDVA improved from 1.12 ± 0.48 logMAR preoperatively to 0.73 ± 0.37 logMAR postoperatively ( P < .0001). The mean CDVA changed from 0.33 ± 0.20 to 0.20 ± 0.11 logMAR ( P < .0001). Postoperatively, the CDVA improved by two or more lines in 45.2% of the eyes and increased by one line in 19.04%, and none of the patients lost lines of CDVA. All of the anterior and posterior corneal tomographic parameters analyzed were significantly improved after surgery, except posterior flat keratometry, which remained unchanged. In 80.95% of the eyes, the postoperative mean keratometry was 50.00 diopters or less. The 6-month RMS for coma-like aberrations also declined significantly from 1.57 ± 0.68 to 1.06 ± 0.42 µm after surgery ( P < .0001). CONCLUSIONS: These results suggest that implanting a 300° arc-length ICRS is a safe and effective procedure for treating patients with moderate to advanced central hyperprolate keratoconus and clear cornea. [ J Refract Surg . 2021;37(4):249–255.]

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 0.05). 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 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.

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.Fernández-Vega Ophthalmological Institute, Oviedo, Spain.Retrospective case series.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.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).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.

Supplemental material, Table_2_(4) for Three-year follow-up of intrastromal corneal ring segment implantation in central keratoconus with regular astigmatism: ‘Bow-tie’ shape by Luis Fernández-Vega-Cueto, Carlos Lisa, Aranzazu Poo-López, José F Alfonso and David Madrid-Costa in European Journal of Ophthalmology

To evaluate the efficacy, safety, and predictability of sequential implantation of Keraring intrastromal corneal ring segments (ICRS) and an Implantable Collamer Lens phakic intraocular lens (pIOL) with corneal relaxing incisions for refractive correction of keratoconus.Fernández-Vega Ophthalmological Institute, Oviedo, Spain.Cohort study.This study comprised patients with keratoconus who had ICRS implantation followed 6 months later by pIOL implantation with corneal relaxing incisions. 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, and 6 months after pIOL implantation.The study enrolled 40 eyes (31 patients). The mean UDVA (decimal) was 0.11 Snellen ± 0.05 (SD) preoperatively, 0.18 ± 0.14 Snellen 6 months after ICRS implantation (P=.001), and 0.50 ± 0.27 Snellen 6 months after pIOL implantation (P.0001). The mean CDVA was 0.56 ± 0.23 Snellen, 0.68 ± 0.25 Snellen, and 0.73 ± 0.20 Snellen, respectively (all P.0001). Six months after pIOL implantation, the efficacy index was 0.88 and the safety index, 1.28. At 6 months, 65% of eyes were within ±1.00 diopter (D) of the desired refraction and 45% were within ±0.50 D. The mean spherical equivalent after pIOL implantation was -1.19 ± 1.33 D.Sequential ICRS and pIOL implantation plus corneal relaxing incisions provided good visual and refractive outcomes, indicating that it is a predictable procedure for refractive correction of keratoconus.No author has a financial or proprietary interest in any material or method mentioned.

To evaluate the optical and visual quality in eyes with diffractive intraocular lenses (IOLs) after myopic laser in situ keratomileusis (LASIK).Fernández-Vega Ophthalmological Institute, Oviedo, Spain.The best corrected visual acuity (BCVA [distance]) at 12.5%, 25.0%, and 100% contrasts under photopic and mesopic conditions; best distance-corrected near acuity; corneal total higher-order aberrations (HOAs); and optical quality by modulation transfer function (MTF) were measured after myopic LASIK in eyes with a spherical AcrySof ReSTOR SN60D3 IOL or an aspheric Acri.LISA 366D IOL and phakic eyes (control).Under photopic conditions at 100% contrast, the BCVA was 0.1 logMAR or better in all groups. At 25.0% and 12.5% contrasts, there were no statistically significant differences between the aspheric IOL group and the spherical IOL or control group (P.01). The control group had better BCVA than the spherical IOL group (P = .0002, 25.0%; P.0001, 12.5%). Under mesopic conditions, the aspheric IOL group had better BCVA than the spherical IOL group at all contrasts (P.01). There was no statistically significant difference between the 2 IOL groups in mean best distance-corrected near acuity or between all 3 groups in HOAs (P.01). With 6.0 mm and 3.0 mm pupils, there were no statistically significant differences in MTF between the aspheric IOL group and the control group; both groups had better MTF than the spherical IOL group with a 6.0 mm pupil (P.01).After LASIK, the aspheric IOL provided better visual quality and optical quality than spherical IOL under mesopic conditions (large pupil).

Existen muchas clasificaciones de queratocono, aunque podemos considerar que ninguna de ellas ha sido aceptada de forma generalizada. Por ello, nos planteamos la posibilidad de clasificar el queratocono considerando que la ectasia se puede desarrollar en una cornea sin astigmatismo o en una cornea que tenga un astigmatismo previo. Uniendo los conceptos de astigmatismo topografico previo (valor y eje) y localizacion y direccion de la ectasia (punto mas delgado de la cornea), podemos obtener una clasificacion en fenotipos independientemente del grado evolutivo del queratocono. El fenotipo que nos encontraremos en el momento del diagnostico sera un balance entre el grado de astigmatismo que la cornea tenia antes de la aparicion de la ectasia y el grado y localizacion de la misma. En algunos casos, el defecto refractivo puede ser elevado, pero la ectasia minima, y en otros, el astigmatismo bajo, pero la ectasia muy evolucionada. Los fenotipos que hemos descrito se pueden considerar como caricaturas, dibujadas con una serie de rasgos basicos. El estudio pormenorizado de cada caso nos dara la justificacion de la morfologia concreta a la que nos enfrentamos y nos dara las claves para su tratamiento. Tratamiento que desarrollaremos en otra ocasion.

Purpose To asses visual quality after bilateral implantation of the Acri.LISA 366D intraocular lens (IOL) (Carl Zeiss Meditec) in patients with high and low–moderate myopia. Methods A total of 304 eyes of 152 patients had bilateral implantation of the Acri.LISA 366D IOL. The patients were divided into 2 groups: low–moderate myopia (IOL power from 15 to 20.5 D) and high myopia (IOL power from 0 to 14.5 D). Monocular and binocular best-corrected distance visual acuity (BCVA) and best distance-corrected near visual acuity (BCNVA), binocular best distance-corrected intermediate visual acuity (BCIVA), and distance contrast sensitivity (OS) under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were determined. Results At the 6-month postoperative visit, there were no statistically significant differences in monocular and binocular BCVA (p=0.13 and p=0.22, respectively). Monocular and binocular BCNVA was comparable between the groups (p=0.26 and p=0.09, respectively). The mean binocular BCIVA changed significantly as a function of the distance of the test (p0.01). Conclusions Bilateral implantation of the Acri.LISA 366D in high myopic eyes provides a satisfactory full range of vision comparable to that obtained in low–moderate myopic eyes.

Purpose To evaluate the efficacy, predictability, and safety of a phakic posterior chamber intraocular Collamer lens (ICL) after penetrating keratoplasty (PKP). Setting Fernandez-Vega Ophthalmological Institute, Oviedo, Spain. Methods A myopic or toric ICL was implanted after PKP in eyes unable to wear glasses or contact lenses and for which corneal laser surgery was contraindicated. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, and endothelial cell count were recorded preoperatively and 24 months postoperatively. Results Preoperatively, the 15 eyes had myopia from −2.00 to −17.00 diopters (D) or astigmatism from −1.50 to −7.00 D. Twenty-four months postoperatively, the mean Snellen decimal UDVA was 0.51 ± 0.30 (SD). The UDVA was 20/40 or better in 7 eyes (46.6%). The mean CDVA was 0.79 ± 0.22. The CDVA was 20/40 or better in 12 eyes (80%) and 20/25 in 6 eyes (40%). No eye lost more than 1 line of acuity, 2 eyes gained 1 line, and 5 eyes gained more than 2 lines; 8 eyes were unchanged. The safety index was 1.58. The spherical equivalent (SE) was within ±1.00 D in 80% of eyes and within ±0.50 D in 66.6% of eyes. The mean postoperative SE was −0.95 ± 1.12 D. At 24 months, the mean vault was 2.06 ± 0.96 and the mean endothelial cell loss, 8.1%. Conclusion Results indicate that phakic intraocular lens implantation is a viable treatment for myopia and astigmatism after PKP in patients for whom glasses, contact lenses, or corneal refractive surgery are contraindicated.