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Ophthalmology. 2007 Sep;114(9):1643-52. Epub 2007 Apr 2.

Intrastromal corneal ring segment implantation by femtosecond laser for keratoconus correction.

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1
Vissum Instituto Oftalmológico de Alicante/Department of Cornea and Refractive Surgery and Division of Ophthalmology, Miguel Hernández University Medical School, Alicante, Spain.

Abstract

PURPOSE:

To report the outcomes after the implantation of intrastromal corneal ring segments (KERARING) aided by femtosecond laser for the correction of keratoconus.

DESIGN:

Prospective consecutive interventional study.

PARTICIPANTS:

Twenty-one eyes of 16 consecutive keratoconic patients with mean age 32+/-10.2 years. Forty-five percent were keratoconus grade I, 20% grade II, 15% grade III, and 20% grade IV.

METHODS:

Intrastromal corneal ring segments KERARING were implanted for keratoconus correction after corneal tunnel creation with the aid of femtosecond laser (IntraLase Corp, Irvine CA).

MAIN OUTCOME MEASURES:

Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive outcome, complete ophthalmologic examination, videokeratography, and corneal higher order aberrations (HOA) were determined or performed before and after surgery at 1 day, 1 week, and 3 and 6 months. In addition, operative and postoperative complications were recorded.

RESULTS:

KERARING implantation significantly increased UCVA from 0.06 to 0.3 (P< or =0.0001), BSCVA from 0.54 to 0.71 (P< or =0.0003), and decreased the spherical equivalent by 2.28 diopters (D) and the average keratometric values (K value) by 2.24 D (P<0.001). There was no significant difference between the 3 and 6 months follow-up. Forty percent (8 eyes with a relatively low RMS of total HOA) showed a nonsignificant increase in the RMS of total HOA and 60% (12 eyes with a relatively higher RMS of total HOA> or =3.0 microm) showed significant (P< or =0.01) decrease in the RMS of total HOA due to a significant (P< or =0.003) reduction in coma and comalike aberrations. The amount of change in corneal curvature (biomechanical response) ranged from a decrease of 18% from its initial value to an increase of 2.75% and was not correlated to any preoperative parameter. Localized infectious keratitis occurred in only 1 eye (4.8%), and incision opacification occurred in 8 eyes (38%).

CONCLUSION:

Intrastromal corneal ring segment implantation with femtosecond laser is an effective method for correcting keratoconus with reduction in corneal HOA in eyes with coma aberration > 3.0 microm.

PMID:
17400293
DOI:
10.1016/j.ophtha.2006.11.033
[Indexed for MEDLINE]
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