Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus
To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients. Retrospective interventional case series. This retrospective study included pediatric patients (aged ≤14 years) with keratoconus and poor corrected...
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| Veröffentlicht in: | American journal of ophthalmology 2017-06, Vol.178, p.51-57 |
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| creator | Abdelmassih, Youssef el-Khoury, Sylvain Dirani, Ali Antonios, Rafic Fadlallah, Ali Cherfan, Carole G. Chelala, Elias Jarade, Elias F. |
| description | To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients.
Retrospective interventional case series.
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.
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.
ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA. |
| doi_str_mv | 10.1016/j.ajo.2017.03.016 |
| format | Article |
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Retrospective interventional case series.
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.
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.
ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.</description><identifier>ISSN: 0002-9394</identifier><identifier>EISSN: 1879-1891</identifier><identifier>DOI: 10.1016/j.ajo.2017.03.016</identifier><identifier>PMID: 28341606</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Age ; Cataracts ; Child ; Collagen ; Corneal Stroma - pathology ; Corneal Stroma - surgery ; Corneal Topography ; Cross-Linking Reagents - pharmacology ; Feasibility studies ; Female ; Follow-Up Studies ; Humans ; Keratoconus - diagnosis ; Keratoconus - physiopathology ; Keratoconus - therapy ; Male ; Ophthalmologic Surgical Procedures - methods ; Patients ; Pediatrics ; Prostheses and Implants ; Prosthesis Design ; Prosthesis Implantation - methods ; Refraction, Ocular ; Retrospective Studies ; Surgeons ; Surgery ; Visual Acuity</subject><ispartof>American journal of ophthalmology, 2017-06, Vol.178, p.51-57</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jun 1, 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c381t-997c51a864b1e6b8c4a14ca1df29961383c44d3e4cc43842732ba9252c8a59a63</citedby><cites>FETCH-LOGICAL-c381t-997c51a864b1e6b8c4a14ca1df29961383c44d3e4cc43842732ba9252c8a59a63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ajo.2017.03.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28341606$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Abdelmassih, Youssef</creatorcontrib><creatorcontrib>el-Khoury, Sylvain</creatorcontrib><creatorcontrib>Dirani, Ali</creatorcontrib><creatorcontrib>Antonios, Rafic</creatorcontrib><creatorcontrib>Fadlallah, Ali</creatorcontrib><creatorcontrib>Cherfan, Carole G.</creatorcontrib><creatorcontrib>Chelala, Elias</creatorcontrib><creatorcontrib>Jarade, Elias F.</creatorcontrib><title>Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus</title><title>American journal of ophthalmology</title><addtitle>Am J Ophthalmol</addtitle><description>To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients.
Retrospective interventional case series.
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.
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.
ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.</description><subject>Adolescent</subject><subject>Age</subject><subject>Cataracts</subject><subject>Child</subject><subject>Collagen</subject><subject>Corneal Stroma - pathology</subject><subject>Corneal Stroma - surgery</subject><subject>Corneal Topography</subject><subject>Cross-Linking Reagents - pharmacology</subject><subject>Feasibility studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Keratoconus - diagnosis</subject><subject>Keratoconus - physiopathology</subject><subject>Keratoconus - therapy</subject><subject>Male</subject><subject>Ophthalmologic Surgical Procedures - methods</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Prostheses and Implants</subject><subject>Prosthesis Design</subject><subject>Prosthesis Implantation - methods</subject><subject>Refraction, Ocular</subject><subject>Retrospective Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Visual Acuity</subject><issn>0002-9394</issn><issn>1879-1891</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcGO1DAMhiMEYmcXHoALqsSFS0vcpGkiTmi0sCNWArFwjjJuukppkyFJkebtyTALBw6cLNuff9n-CXkBtAEK4s3UmCk0LYW-oawplUdkA7JXNUgFj8mGUtrWiil-QS5Tmkoqet4_JRetZBwEFRuS7sxo87Eyfqiux9GhwWMVxurO_litz87M1c7naDBEb0vyxfn70rxfSrPaLYfZ-GyyC_63wjaGlOrZ-e8nzPnqsx2cydFh9dFGkwMGv6Zn5Mlo5mSfP8Qr8u399dftTX376cNu--62RiYh10r12IGRgu_Bir1EboCjgWFslRLAJEPOB2Y5ImeStz1r90a1XYvSdMoIdkVen3UPMZRrUtaLS2jnsrMNa9IgJbRCdhQK-uofdApr9GU7Dar0OwWSFwrOFJ7ujHbUh-gWE48aqD45oiddHNEnRzRlulTKzMsH5XW_2OHvxB8LCvD2DNjyip_ORp3QWY_lc9Fi1kNw_5H_BS80m3s</recordid><startdate>201706</startdate><enddate>201706</enddate><creator>Abdelmassih, Youssef</creator><creator>el-Khoury, Sylvain</creator><creator>Dirani, Ali</creator><creator>Antonios, Rafic</creator><creator>Fadlallah, Ali</creator><creator>Cherfan, Carole G.</creator><creator>Chelala, Elias</creator><creator>Jarade, Elias F.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201706</creationdate><title>Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus</title><author>Abdelmassih, Youssef ; el-Khoury, Sylvain ; Dirani, Ali ; Antonios, Rafic ; Fadlallah, Ali ; Cherfan, Carole G. ; Chelala, Elias ; Jarade, Elias F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c381t-997c51a864b1e6b8c4a14ca1df29961383c44d3e4cc43842732ba9252c8a59a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Age</topic><topic>Cataracts</topic><topic>Child</topic><topic>Collagen</topic><topic>Corneal Stroma - pathology</topic><topic>Corneal Stroma - surgery</topic><topic>Corneal Topography</topic><topic>Cross-Linking Reagents - pharmacology</topic><topic>Feasibility studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Keratoconus - diagnosis</topic><topic>Keratoconus - physiopathology</topic><topic>Keratoconus - therapy</topic><topic>Male</topic><topic>Ophthalmologic Surgical Procedures - methods</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Prostheses and Implants</topic><topic>Prosthesis Design</topic><topic>Prosthesis Implantation - methods</topic><topic>Refraction, Ocular</topic><topic>Retrospective Studies</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Visual Acuity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Abdelmassih, Youssef</creatorcontrib><creatorcontrib>el-Khoury, Sylvain</creatorcontrib><creatorcontrib>Dirani, Ali</creatorcontrib><creatorcontrib>Antonios, Rafic</creatorcontrib><creatorcontrib>Fadlallah, Ali</creatorcontrib><creatorcontrib>Cherfan, Carole G.</creatorcontrib><creatorcontrib>Chelala, Elias</creatorcontrib><creatorcontrib>Jarade, Elias F.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Abdelmassih, Youssef</au><au>el-Khoury, Sylvain</au><au>Dirani, Ali</au><au>Antonios, Rafic</au><au>Fadlallah, Ali</au><au>Cherfan, Carole G.</au><au>Chelala, Elias</au><au>Jarade, Elias F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus</atitle><jtitle>American journal of ophthalmology</jtitle><addtitle>Am J Ophthalmol</addtitle><date>2017-06</date><risdate>2017</risdate><volume>178</volume><spage>51</spage><epage>57</epage><pages>51-57</pages><issn>0002-9394</issn><eissn>1879-1891</eissn><abstract>To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients.
Retrospective interventional case series.
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.
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.
ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28341606</pmid><doi>10.1016/j.ajo.2017.03.016</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Age Cataracts Child Collagen Corneal Stroma - pathology Corneal Stroma - surgery Corneal Topography Cross-Linking Reagents - pharmacology Feasibility studies Female Follow-Up Studies Humans Keratoconus - diagnosis Keratoconus - physiopathology Keratoconus - therapy Male Ophthalmologic Surgical Procedures - methods Patients Pediatrics Prostheses and Implants Prosthesis Design Prosthesis Implantation - methods Refraction, Ocular Retrospective Studies Surgeons Surgery Visual Acuity |
| title | Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus |
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