Intrastromal corneal ring segment implantation in pediatric patients with keratoconus: long-term follow-up
DOI:
https://doi.org/10.31288/oftalmolzh20234913Keywords:
Keratoconus, Intrastromal corneal ring segments, visual acuity, keratometryAbstract
Purpose: To evaluate the long-term outcomes of Intrastromal Corneal Ring Segments (ICRS) implantation in pediatric patients with keratoconus.
Methods: Retrospective analysis of eyes with ICRS implantation in pediatric age. Uncorrected (UCVA) and best-corrected (BCVA) visual acuity, maximum and minimum keratometry (Kmax and Kmin), and corneal thickness at the thinnest point (CTTP) were evaluated preoperatively, 6 to 12 months after surgery, 5 years after surgery, and at the last follow-up visit (>10 years after surgery).
Results: Fourteen eyes (10 patients) were included. In 5 eyes all ICRS were explanted and in 1 eye, one of the segments was explanted. UCVA (p=0.028) and BCVA (p=0.028) improved 6 to 12 months after surgery and remained stable afterwards (p>0.999). There was a decrease in Kmax and Kmin 6 to 12 months after surgery (p<0.001 and p=0.012, respectively), with subsequent stability at the 5-year follow-up (p=0.736 and p=0.056, respectively). Kmax remained stable at the last follow-up (p>0.999) but there was an increase in Kmin (p=0.028). There were no changes in CTTP (p=0.097).
Conclusion: ICRS implantation seems to be a minimally invasive, and reversible procedure that leads to improvement of BCVA and keratometry readings. Despite this, the need for explantation increased overtime.
References
Mukhtar S, Ambati BK. Pediatric keratoconus: a review of the literature. Int Ophthalmol. 2018;38(5):2257-2266. https://doi.org/10.1007/s10792-017-0699-8
Rabinowitz YS. Keratoconus. Surv Ophthalmol. 1998;42(4):297-319. https://doi.org/10.1016/S0039-6257(97)00119-7
Buzzonetti L, Bohringer D, Liskova P, Lang S, Valente P. Keratoconus in children: a literature review. Cornea. 2020;39(12):1592-1598. https://doi.org/10.1097/ICO.0000000000002420
Park SE, Tseng M, Lee JK. Effectiveness of intracorneal ring segments for keratoconus. Curr Opin Ophthalmol. 2019;30(4):220-228. https://doi.org/10.1097/ICU.0000000000000582
Kobashi H, Rong SS. Corneal collagen cross-linking for keratoconus: systematic review. Biomed Res Int. 2017;2017:8145651. https://doi.org/10.1155/2017/8145651
Feizi S, Javadi MA, Karimian F, Abolhosseini M, Moshtaghion S, Naderi A, et al. Penetrating Keratoplasty versus Deep Anterior Lamellar Keratoplasty in children and adolescents with keratoconus. Am J Ophthalmol. 2021;226:13-21. https://doi.org/10.1016/j.ajo.2021.01.010
Kanellopoulos AJ, Pe LH, Perry HD, Donnenfeld ED. Modified Intracorneal Ring Segment Implantations (INTACS) for the management of moderate to advanced keratoconus: efficacy and complications. Cornea. 2006;25(1):29-33. https://doi.org/10.1097/01.ico.0000167883.63266.60
Shetty R, Kurian M, Anand D, Mhaske P, Narayana KM, Sherry BK. Intacs in advanced keratoconus. Cornea. 2008;27(9):1022-1029. https://doi.org/10.1097/ICO.0b013e318172fc54
Alió JL, Shabayek MH, Artola A. Intracorneal ring segments for keratoconus correction: long-term follow-up. J Cataract Refract Surg. 2006;32(6):978-985. https://doi.org/10.1016/j.jcrs.2006.02.044
Baptista PM, Marques JH, Neves MM, Gomes M, Oliveira L. Asymmetric Thickness Intracorneal Ring Segments for Keratoconus. Clin Ophthalmol. 2020;16;14:4415-4421. https://doi.org/10.2147/OPTH.S283387
Abreu AC, Malheiro L, Coelho J, Neves MM, Gomes M, Oliveira L, et al. Implantation of intracorneal ring segments in pediatric patients: long-term follow-up. Int Med Case Rep J. 2018;11:23-27. https://doi.org/10.2147/IMCRJ.S151383
Ertan A, Ozkilic E. Effect of age on outcomes in patients with keratoconus treated by Intacs using a Femtosecond Laser. J Refract Surg. 2008;24(7):690-695. https://doi.org/10.3928/1081597X-20080901-08
Alfonso JF, Fernández-Vega-Cueto L, Lisa C, Monteiro T, Madrid-Costa D. Long-term follow-up of intrastromal corneal ring segment implantation in pediatric keratoconus. Cornea. 2019;38(7):840-846. https://doi.org/10.1097/ICO.0000000000001945
Ferrara P, Torquetti L, Ferrara G. Intrastromal corneal ring segments in children with keratoconus. Int J Keratoconus Ectatic Corneal Dis. 2017;6(2):45-48. https://doi.org/10.5005/jp-journals-10025-1142
Méndez EA, Roys N, Mejía ME, Plata MC, Rosenstiehl SM. Results of follow-up in pediatric keratoconus treated with intracorneal ring segments Implantation alone or in combination with corneal cross-linking. J Pediatr Ophthalmol Strabismus. 2022;59(2):118-127. https://doi.org/10.3928/01913913-20210719-02
Abdelmassih Y, el-Khoury S, Dirani A, Antonios R, Fadlallah A, Cherfan CG, et al. Safety and efficacy of sequential intracorneal ring segment implantation and cross-linking in pediatric keratoconus. Am J Ophthalmol. 2017;178:51-57. https://doi.org/10.1016/j.ajo.2017.03.016
Monteiro T, Alfonso JF, Freitas R, Freitas R, Franqueira N, Faria-Correia F, et al. Comparison of complication rates between manual and Femtosecond Laser-assisted techniques for intrastromal corneal ring segments implantation in keratoconus. Curr Eye Res. 2019;44(12):1291-1298. https://doi.org/10.1080/02713683.2019.1635165
McLintock CA, McKelvie J, Li Y, Hamada S, Lake D. Ferrara rings for visual rehabilitation in eyes with keratoconus and previous cross-linking using the Ferrara ring nomogram. Vision. 2021;5(4):45. https://doi.org/10.3390/vision5040045
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Castro C., Silva N., Pires S., Abreu A. C., Neves M. M., Gomes M., Oliveira L., Menéres P.
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) that allows users to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author as long as they cite the source.
COPYRIGHT NOTICE
Authors who publish in this journal agree to the following terms:
- Authors hold copyright immediately after publication of their works and retain publishing rights without any restrictions.
- The copyright commencement date complies the publication date of the issue, where the article is included in.
DEPOSIT POLICY
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) during the editorial process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work with an acknowledgement of its initial publication in this journal.
- Post-print (post-refereeing manuscript version) and publisher's PDF-version self-archiving is allowed.
- Archiving the pre-print (pre-refereeing manuscript version) not allowed.
