New generation intraocular lens implantations in advanced-stage keratoconus cases

Yıl 2019, Cilt: 12 Sayı: 3, 397 - 406, 31.12.2019

Cüneyt Karaarslan

https://doi.org/10.26559/mersinsbd.639076

Öz

Aim: The
aim of this study is to examine the applicability of intracorneal ring (ICR)
surgery, with or without collagen cross-linking (CXL) and subsequent indwelling
new generation foldable ıntraocular lens placement in patients with severe
keratoconus. Methods: A retrospective clinical observation study of a
7-year consecutive case series of 1,068 patients with keratoconus implanted
with Keraring® ICRs, with or without CXL and new generation foldable
intraocular lens implantation was completed. Follow-up examinations to assess
visual acuity, intraocular pressure, and signs of complications were performed
3 days and 3 weeks postoperatively, monthly thereafter for 3 months, at the end
of month 6 and 1 year. Results: ICRs were implanted alone in 607 eyes, with ICLs in 111 eyes, and with
PCIOLs in 198 eyes. Adjunct CXL was performed in 957 ICR-alone eyes, 119
ICR+ICL eyes, and ICR+PCIOL 144 eyes. All treatment plans reduced refraction
prescription strength, reduced corneal curvature, and improved patients’ visual
acuity substantially. Corneal topography showed marked flattening in all eyes.
Corneal irritation due to ICR extrusion led to ICR explantation from 18 eyes
(0.8%). Short-term elevation of intraocular pressure in 3 patients with ICL
implantation was resolved with 2% mannitol (100 ml during ICL placement plus
100 ml after surgery). Conclusion: Surgical
implantation of new generation foldable phakic or new generation foldable
multifocal pseudophakic intraocular lenses in patients with advanced
keratoconus may provide better visual acuity and rehabilitation in addition to
the combination of CXL and ICR. Therefore, these surgical procedures offer
better options for patients with advanced keratoconus than keratoplasty
procedures that are more invasive, expensive and having risks such as tissue
rejection.

Anahtar Kelimeler

: Collagen cross-linking, intracorneal ring, intraocular lens, keratoconus

İleri evre keratokonuslu olgularda yeni nesil intraoküler lens implantasyonları

Öz

Amaç: Bu çalışmada, ileri evre
keratokonuslu hastalarda, kollajen çapraz bağlama (CXL) uygulanan veya
uygulanmayan intra-korneal halka (ICR) cerrahili hastaların ve bunu takip eden
kalıcı lens yerleştirme işlemlerinin sonuçlarının karşılaştırılması amaçlandı. Yöntem: Kollajen çapraz bağlama
uygulanan veya uygulanmayan Keraring® ICR takılmış keratokonuslu, ve daha
sonradan daha iyi görme netliği için gereksinim gösteren uygun vakalara yeni
nesil IOL implantasyonu da yapılan 1068 hastayı 
kapsayan 7 yıllık ardışık bir vaka serisinin retrospektif klinik gözlem
çalışması tamamlandı. Görme keskinliği, göz içi basıncı ve komplikasyonları
değerlendirmek için takip muayeneleri, ameliyat sonrası, 3 gün, 3 hafta, 3 ay,
6 ay ve 1 yıl sonunda gerçekleştirildi. Bulgular:
Intrakorneal halka 607 göze yalnız, 111 göze yeni nesil ICL ve 198 göze yeni
nesil multifokal katlanır PCIOL ile implante edildi. Yardımcı CXL uygulaması,
957 ICR-gözde yalnız, 119 gözde ICR + yeni nesil ICL ile ve 144 gözde ICR +
yeni nesil multifocal katlanır PCIOL ile uygulandı. Tüm tedavi planları,
hastaların refraksiyon değerlerinde ve kornea eğriliğinde azalmaya neden oldu
ve görme keskinliğini büyük ölçüde iyileştirdi. Tüm gözlerde kornea
topografisindeki dikliklerde  belirgin
bir düzleşme izlendi. ICR ekstrüzyonuna bağlı kornea tahrişi 18 gözde (%0.8)
ICR eksplantasyonuna yol açtı. 3 hastada, ICL implantasyonu uygulaması
nedeniyle kısa süreli göz içi basıncı yükselmesi görüldü ve toplam 200 ml
%2’lik mannitol ile çözüldü (100 ml ICL implantasyonu sırasında ve post-op 100
ml ilave olarak). Sonuç: İleri evre
keratokonuslu hastalarda, CXL ve ICR kombinasyonuna ek olarak yeni nesil fakik
ya da  yeni nesil katlanır pseudofakik
göz içi lenslerin cerrahi implantasyonu, çok daha iyi bir görme keskinliği ve
rehabilitasyonu sağlayabilmektedir. Bu sebeple, bu cerrahi uygulamalar, uygun
ileri evre keratokonuslu hastalarda daha 
invazif, pahalı ve doku reddi riski gibi tehlikelere sahip olan
keratoplasti girişimlerine göre önceden davranıldığında çok daha iyi seçenekler
sunmaktadır.

Anahtar Kelimeler

Intrakorneal halka, intraoküler lens, keratokonus, kollajen çapraz bağlama

Kaynakça

• REFERANSLAR1. Rabinowitz YS. Keratoconus. Surv Ophthalmol 1998;42(4):297–319.
• 2. Assiri AA, Yousuf BI, Quantock AJ, Murphy PJ. Incidence and severity of keratoconus in Asir province, Saudi Arabia. Br J Ophthalmol 2005;89(11):1403–1406. Erratum in: Br J Ophthalmol. 2006;90(8):1071.
• 3. Léoni-Mesplié S, Mortemousque B, Touboul D, Malet F, Praud D, Mesplié N, Colin J. Scalability and severity of keratoconus in children. Am J Ophthalmol 2012;154(1):56–62.
• 4. Roy AS, Dupps WJ. Patient-specific computational modeling of keratoconus progression and differential responses to collagen cross-linking. Investig Ophthalmol Vis Sci 2011;52: 9174–9187.
• 5. Michieletto P, Balestrazzi A, Balestrazzi A, Mazzotta C, Occhipinti I, Rossi T. Factors predicting unsuccessful big bubble deep lamellar anterior keratoplasty. Ophthalmologica 2006;220(6):379–382.
• 6. Shi W, Li S, Gao H, Wang T, Xie L. Modified deep lamellar keratoplasty for the treatment of advanced-stage keratoconus with steep curvature. Ophthalmology 2010;117(2):226–231.
• 7. Seitz B, Cursiefen C, El-Husseiny M, Viestenz A, Langenbucher A, Szentmáry N. [DALK and penetrating laser keratoplasty for advanced keratoconus (German)]. Ophthalmologe 2013; 110(9):839–848.
• 8. Seitz B, Langenbucher A, Hager T, Janunts E, El-Husseiny M, Szentmáry N. Penetrating keratoplasty for keratoconus - excimer versus femtosecond laser trephination. Open Ophthalmol J 2017;11:225–240.
• 9. Blériot A, Martin E, Lebranchu P, Zimmerman K, Libeau L, Weber M, Vabres B, Orignac I. [Comparison of anatomic and functional results between Z6 femtosecond laser assisted and manual trephination in deep anterior lamellar keratoplasty for advanced keratoconus (French)]. J Fr Ophtalmol 2017;40(7):571–579.
• 10. Labiris G, Giarmoukakis A, Sideroudi H, Gkika M, Fanariotis M, Kozobolis V. Impact of keratoconus, cross-linking and cross-linking combined with photorefractive keratectomy on self-reported quality of life. Cornea 2012;31(7):734–739.
• 11. Bubnova IA, Kuznetsov AV, Zelyanina EV, Bubnova IA, Kuznetsov AV, Zelyanina EV. [Long-term efficacy of corneal collagen cross-linking in patients with progressive keratoconus (Russian)]. Vestn Oftalmol. 2015;131(5):38–42.
• 12. Gauthier AS, Friot M, Montard R, Saleh M, Delbosc B. [Femtosecond-assisted Ferrara intrastromal corneal ring implantation for treatment of keratoconus: Functional outcomes at one year]. J Fr Ophtalmol 2016;39(5):428–436.
• 13. Belin MW, Duncan JK. Keratoconus: The ABCD Grading System. Klin Monbl Augenheilkd 2016;233:701–707.
• 14. Raiskup F, Kissner A, Hoyer A, Spörl E, Pillunat LE. [Corneal scar development after cross-linking in keratoconus (German)]. Ophthalmologe 2010;107(9):837–842.
• 15. Coskunseven E, Kymionis GD, Tsiklis NS, Atun S, Arslan E, Jankov MR, Pallikaris IG. One-year results of intrastromal corneal ring segment implantation (KeraRing) using femtosecond laser in patients with keratoconus. Am J Ophthalmol 2008;145(5):775–779.
• 16. Kampik D, Koch M, Kampik K, Geerling G. Corneal riboflavin/UV-A collagen cross-linking (CXL) in keratoconus: two-year results. Klin Monbl Augenheilkd 2011;228(6):525–530.
• 17. Lam FC, Bhatt PR, Ramaesh K. Spontaneous perforation of the cornea in mild keratoconus. Cornea 2011;30(1):103–104.
• 18. Savini G, Abbate R, Hoffer KJ, Mularoni A, Imburgia A, Avoni L, D'Eliseo D, Schiano-Lomoriello D. Intraocular lens power calculation in eyes with keratoconus. J Cataract Refract Surg 2019;45:576–581.
• 19. Colak HN, Kantarci FA, Yildirim A, Tatar MG, Goker H, Uslu H, Gurler B. Comparison of corneal topographic measurements and high order aberrations in keratoconus and normal eyes. Cont Lens Anterior Eye 2016;39(5):380–384.
• 20. Kamiya K, Kono Y, Takahashi M, Shoji N. Comparison of simulated keratometry and total refractive power for keratoconus according to the stage of Amsler-Krumeich Classification. Sci Rep 2018;8(1):12436.
• 21. Shao P, Eltony AM, Seiler TG, Tavakol B, Pineda R, Koller T, Seiler T, Yun SH. Spatially-resolved Brillouin spectroscopy reveals biomechanical abnormalities in mild to advanced keratoconus in vivo. Sci Rep 2019;9:7467.
• 22. Yousefi S, Yousefi E, Takahashi H, Hayashi T, Tampo H, Inoda S, Arai Y, Asbell P. Keratoconus severity identification using unsupervised machine learning. PLoS One 2018; 13(11):e0205998.
• 23. Mastropasqua L, Nubile M, Salgari N, Mastropasqua R. Femtosecond laser-assisted stromal lenticule addition keratoplasty for the treatment of advanced keratoconus: A preliminary study. J Refract Surg 2018;34(1):36–44.
• 24. Sitnik GV, Slonimskiy AY, Slonimskiy YB, Imshenetskaya TA. Femtolaser-assisted refractive autokeratoplasty in the management of advanced keratoconus (three-year outcomes) (Russian)]. Vestn Oftalmol 2019;135(1):28–35.
• 25. Khakshoor H, Eslampoor A, Rad SS, Vejdani A. Modified deep anterior lamellar keratoplasty for the treatment of advanced keratoconus with steep corneal curvature to help in eliminating the wrinkles in the Descemet's membrane. Indian J Ophthalmol 201462(4):392–395.
• 26. Seitz B, Szentmáry N, Langenbucher A, Hager T, Viestenz A, Janunts E, El-Husseiny M. [PKP for keratoconus - from hand/motor trephine to excimer laser and back to femtosecond laser (German)]. Klin Monbl Augenheilkd 2016; 233(6):727–736.
• 27. Panda A, Bageshwar LM, Ray M, Singh JP, Kumar A. Deep lamellar keratoplasty versus penetrating keratoplasty for corneal lesions. Cornea 1999;18:172–175.
• 28. Anwar M, Techmqnn KD. Big-bubble technique to bare Descmet’s membrane in anterior lamellar keratoplasty. J Cateract Refract Surg 2002;28:398–403.
• 29. Fung SS, Aiello F, Maurino V. Outcomes of femtosecond laser-assisted mushroom-configuration keratoplasty in advanced keratoconus. Eye (Lond) 2016;30(4):553–561.
• 30. Fuentes E, Sandali O, El Sanharawi M, Basli E, Hamiche T, Goemaere I, Borderie V, Bouheraoua N, Laroche L. Anatomic predictive factors of acute corneal hydrops in keratoconus: An optical coherence tomography study. Ophthalmology 2015;122(8):1653–1659.