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Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus.
- Source :
-
American journal of ophthalmology [Am J Ophthalmol] 2017 Jun; Vol. 178, pp. 51-57. Date of Electronic Publication: 2017 Mar 22. - Publication Year :
- 2017
-
Abstract
- Purpose: To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients.<br />Design: Retrospective interventional case series.<br />Methods: This retrospective study included pediatric patients (aged ≤14 years) with keratoconus and poor corrected distance visual acuity (CDVA) that underwent ICRS implantation and cross-linking (CXL). ICRS were inserted under topical anesthesia after creating a corneal tunnel with a femtosecond laser. Cross-linking was performed 1 month subsequently. Records were reviewed and data collected preoperatively and at 6 months, 1 year, 2 years, and 4 years postoperatively.<br />Results: Twelve patients (17 eyes; 10 male, 2 female) aged 9-14 years (mean age 12.3 years) received ICRS implantation followed by CXL. Follow-up times ranged from 6 months to 4 years after surgery. At the 6-month follow-up all eyes were evaluated; at the 1-year, 2-year, and 4-year follow-up 11, 10, and 7 eyes were evaluated, respectively. At the 6-month follow-up, mean CDVA in comparison to preoperative levels improved significantly (P = .001) from 0.30 ± 0.19 logMAR to 0.12 ± 0.1 logMAR; mean uncorrected distance visual acuity (UDVA) also improved significantly from 0.90 ± 0.50 logMAR to 0.43 ± 0.31 logMAR. A significant decrease in both keratometry readings and spherical equivalent (from -4.0 to -1.56 diopters) was also noted after ICRS insertion. At the 1-year, 2-year, and 4-year follow-up refractive values remained relatively stable in comparison to the 6-month follow-up, except for a minor but significant improvement in cylinder and, at 4 years, in UDVA. All patients tolerated the surgery well and no intraoperative or postoperative complications were reported, except for 1 ring segment that had to be removed after 2 years owing to vascularization and corneal thinning.<br />Conclusion: ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Child
Corneal Stroma pathology
Corneal Topography
Female
Follow-Up Studies
Humans
Keratoconus diagnosis
Keratoconus physiopathology
Male
Prosthesis Design
Retrospective Studies
Visual Acuity
Corneal Stroma surgery
Cross-Linking Reagents pharmacology
Keratoconus therapy
Ophthalmologic Surgical Procedures methods
Prostheses and Implants
Prosthesis Implantation methods
Refraction, Ocular
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1891
- Volume :
- 178
- Database :
- MEDLINE
- Journal :
- American journal of ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 28341606
- Full Text :
- https://doi.org/10.1016/j.ajo.2017.03.016