Skip to main content

Intrastromal corneal ring segment implantation in 219 keratoconic eyes at different stages

Graefe's Archive for Clinical and Experimental Ophthalmology volume 249, Article number: 1705 (2011) Cite this article

Abstract

Background

To evaluate the visual and refractive outcomes of intrastromal corneal ring segment (ICRS) in keratoconic eyes at different stages.

Methods

Two hundred and nineteen keratoconic eyes were divided into three groups as a function of stage of keratoconus (stages I, II and III). There were 115 eyes with stage I, 84 eyes with stage II and 20 eyes with stage III. Snellen uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (CDVA), and residual refractive errors analyzed using vector analysis were recorded before surgery and 6 months post-surgery.

Results

For stage I, UDVA changed from 0.26 ± 0.19 pre-surgery to 0.58 ± 0.30 post-surgery (P < 0.001) and CDVA from 0.79 ± 0.19 to 0.90 ± 0.13 (P < 0.0001). For stage II, UDVA was 0.17 ± 0.15 pre-surgery and 0.35 ± 0.22 post-surgery (P < 0.001) and CDVA changed from 0.56 ± 0.21 to 0.67 ± 0.20 after the surgery (P < 0.0001). For stage III, statistically significant differences both for UDVA and CDVA were not found (P = 0.08 and P = 0.01 respectively). For stage I, 52.16% of the eyes gained lines of CDVA, 39.13% did not change their CDVA, and 8.67% lost lines of CDVA. For stage II, 65.48% of the eyes gained lines of CDVA, 20.24% had unchanged CDVA, and 14.28% lost lines of CDVA. For stage III, 60% of the eyes gained >2 lines of CDVA, 25% did not change their CDVA, and 15% lost lines of CDVA. A significant decrease in the spherical equivalent after surgery was found for stages I and II (P < 0.0001) but not for stage III (P = 0.07).

Conclusion

ICRS implantation is an effective procedure for keratoconus treatment, being more effective for moderate keratoconus.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2

References

  1. Krachmer JH, Feder RS, Belin MW (1984) Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol 28:293–322

    PubMed  Article  CAS  Google Scholar 

  2. Rabinowitz YS (1988) Keratoconus. Surv Ophthalmol 42:297–319

    Article  Google Scholar 

  3. Ertan A, Kamburoglu BM (2006) Intacs insertion with the femtosecond laser for the management of keratoconus. One-year results. J Cataract Refract Surg 32:2039–2042

    PubMed  Article  Google Scholar 

  4. Ertan A, Kamburoglu G (2008) Intacs implantation using a femtosecond laser for management of keratoconus: Comparison of 306 cases in different stages. J Cataract Refract Surg 34:1521–1526

    PubMed  Article  Google Scholar 

  5. Coskunseven E, Kymionis GD, Tsiklis NS, Atun S, Arslan E, Jankov MR, Pallikaris IG (2008) One-year results of intrastromal corneal ring segment implantation (KeraRing) using femtosecond laser in patients with keratoconus. Am J Ophthalmol 145:775–9

    PubMed  Article  Google Scholar 

  6. Shabayek MH, Alió JL (2007) Intrastromal corneal ring segment implantation by femtosecond laser for keratoconus correction. Ophthalmology 114:1643–1652

    PubMed  Article  Google Scholar 

  7. Torquetti L, Berbel RF, Ferrara P (2009) Long-term follow-up of intrastromal corneal ring segments in keratoconus. J Cataract Refract Surg 35:1768–1773

    PubMed  Article  Google Scholar 

  8. Piñero DP, Alió JL, Teus MA, Barraquer RI, Michael R, Jiménez R (2010) Modification and refinement of astigmatism in keratoconic eyes with intrastromal corneal ring segments. J Cataract Refract Surg 36:1562–1572

    PubMed  Article  Google Scholar 

  9. Kubaloglu A, Cinar Y, Sari ES, Koytak A, Ozdemir B, Ozertürk Y (2010) Comparison of 2 intrastromal corneal ring segment models in the management of keratoconus. J Cataract Refract Surg 36:978–85

    PubMed  Article  Google Scholar 

  10. Shetty R, Kurian M, Anand D, Mhaske P, Narayana KM, Shetty BK (2008) Intacs in advanced keratoconus. Cornea 27:1022–1029

    PubMed  Article  Google Scholar 

  11. Ertan A, Ozkilic E (2008) Effect of age on outcomes in patients with keratoconus treated by Intacs using a femtosecond laser. J Refract Surg 24:690–695

    PubMed  Google Scholar 

  12. Zare MA, Hashemi H, Salari MR (2007) Intracorneal ring segment implantation for the management of keratoconus: safety and efficacy. J Cataract Refract Surg 33:1886–1891

    PubMed  Article  Google Scholar 

  13. Kymionis GD, Siganos CS, Tsiklis NS, Anastasakis A, Yoo SH, Pallikaris AI, Astyrakakis N, Pallikaris IG (2007) Long-term follow-up of Intacs in keratoconus. Am J Ophthalmol 143:236–244

    PubMed  Article  Google Scholar 

  14. Colin J (2006) European clinical evaluation: use of Intacs for the treatment of keratoconus. J Cataract Refract Surg 32:747–755

    PubMed  Article  Google Scholar 

  15. Kanellopoulos AJ, Pe LH, Perry HD, Donnenfeld ED (2006) Modified intracorneal ring segment implantations (INTACS) for the management of moderate to advanced keratoconus; efficacy and complications. Cornea 25:29–33

    PubMed  Article  Google Scholar 

  16. Kwitko S, Severo NS (2004) Ferrara intracorneal ring segments for keratoconus. J Cataract Refract Surg 30:812–820

    PubMed  Article  Google Scholar 

  17. Miranda D, Sartori M, Francesconi C, Allemann N, Ferrara P, Ferrara CM (2003) Intrastromal corneal ring segments for severe keratoconus. J Refract Surg 19:645–653

    PubMed  Google Scholar 

  18. Siganos CS, Kymionis GD, Kartakis N, Theodorakis MA, Astyrakakis N, Pallikaris IG (2003) Management of keratoconus with Intacs. Am J Ophthalmol 135:64–70

    PubMed  Article  CAS  Google Scholar 

  19. Boxer Wachler BS, Chandra NS, Chou B, Korn TS, Nepomuceno R, Christie JP (2003) Intacs for keratoconus. Ophthalmology 110:1031–1040, errata, 1475

    PubMed  Article  Google Scholar 

  20. Siganos D, Ferrara P, Chatzinikolas K, BessisN PG (2002) Ferrara intrastromal corneal rings for the correction of keratoconus. J Cataract Refract Surg 28:1947–1951

    PubMed  Article  Google Scholar 

  21. Colin J, Cochener B, Savary G, Malet F, Holmes-Higgin D (2001) INTACS inserts for treating keratoconus; one-year results. Ophthalmology 108:1409–1414

    PubMed  Article  CAS  Google Scholar 

  22. Güell JL, Morral M, Salinas C, Elies D, Fris O, Manero F (2010) Four-year follw-up of intrastromal corneal ring segments in patients with keratoconus. J Emmetropia 1:9–15

    Google Scholar 

  23. Ferrara P, Torquetti L. (2010) Corneal endothelial profile after Ferrara ring implantation. J Emmetropia 1:29–32

    Google Scholar 

  24. Piñero DP, Alio JL, Barraquer RI, Michael R, Jiménez R (2010) Corneal biomechanics, refraction, and corneal aberrometry in keratoconus: an integrated study. Invest Ophthalmol Vis Sci 51:1948–55

    PubMed  Article  Google Scholar 

  25. Maeda N, Klyce SD, Smolek MK (1995) Comparison of methods for detecting keratoconus using videokeratography. Arch Ophthalmol 113:870–874

    PubMed  CAS  Google Scholar 

  26. Rabinowitz YS, Rasheed K, Yang H, Elashoff J (1998) Accuracy of ultrasonic pachymetry and videokeratography in detecting keratoconus. J Cataract Refract Surg 24(196):201

    Google Scholar 

  27. Fam HB, Lim KL (2006) Corneal elevation indices in normal and keratoconic eyes. J Cataract Refract Surg 32:1281–1287

    PubMed  Article  Google Scholar 

  28. Thibos LN, Horner D (2001) Power vector analysis of the optical outcome of refractive surgery. J Cataract Refract Surg 27:80–85

    PubMed  Article  CAS  Google Scholar 

  29. Ertan A, Colin J (2007) Intracorneal rings for keratoconus and keratectasia. J Cataract Refract Surg 33:1303–1314

    PubMed  Article  Google Scholar 

  30. Barraquer JI (1949) Queratoplastia refractiva, estudios e informaciones. Oftalmologicas (Barcelona) 2:10–30

    Google Scholar 

  31. Barraquer JI (1966) Modification of refraction by means of intracorneal inclusion. Int Ophthalmol Clin 6:53–78

    PubMed  CAS  Google Scholar 

  32. Patel S, Marshall J, Fitzke FW III (1995) Model for deriving the optical performance of the myopic eye corrected with an intracorneal ring. J Refract Surg 11:248–52

    PubMed  CAS  Google Scholar 

  33. Nepomuceno RL, Boxer Wachler BS, Weissman BA (2003) Feasibility of contact lens fitting on keratoconus patients with INTACS inserts. Cont Lens Anterior Eye 26:175–80

    PubMed  Article  Google Scholar 

  34. Uçakhan OO, Kanpolat A, Ozdemir O (2006) Contact lens fitting for keratoconus after Intacs placement. Eye Contact Lens 32:75–7

    PubMed  Article  Google Scholar 

  35. Hladun L, Harris M (2004) Contact lens fitting over intrastromal corneal rings in a keratoconic patient. Optometry 75:48–54

    PubMed  Google Scholar 

  36. Alfonso JF, Lisa C, Fernández-Vega L, Madrid-Costa D, Poo-López A, Montés-Micó R (2011) Intrastromal corneal ring segments and posterior chamber phakic intraocular lens implantation for keratoconus correction. J Cataract Refract Surg 37:706–713

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Fernández-Vega Ophthalmological Institute, Oviedo, Spain

    José F. Alfonso, Carlos Lisa & Luis Fernández-Vega

  2. Surgery Department, School of Medicine, University of Oviedo, Oviedo, Spain

    José F. Alfonso & Luis Fernández-Vega

  3. Optics Department, Faculty of Physics, University of Valencia, Valencia, Spain

    David Madrid-Costa & Robert Montés-Micó

  4. Instituto Oftalmológico Fernández-Vega, Avda. Dres. Fernández-Vega 34, 33012, Oviedo, Spain

    José F. Alfonso

Authors
  1. José F. Alfonso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Lisa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luis Fernández-Vega
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David Madrid-Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert Montés-Micó
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to José F. Alfonso.

Additional information

The authors have no proprietary interest in any of the materials mentioned in this article.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Alfonso, J.F., Lisa, C., Fernández-Vega, L. et al. Intrastromal corneal ring segment implantation in 219 keratoconic eyes at different stages. Graefes Arch Clin Exp Ophthalmol 249, 1705 (2011). https://doi.org/10.1007/s00417-011-1759-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00417-011-1759-9

Keywords

  • Intrastromal corneal ring
  • Keratoconus
  • Femtosecond laser