New generation intraocular lens implantations in advanced keratoconus cases

Entry

Keratoconus (ectatic cornea)

dystrophy), cornea more central

thinning and taking a conical shape

characterized by progressive and inflammatory

It is an eye disease. Usually every

blurred and/or double vision in both eyes

causes visual impairment

and it occurs in about 1/2000 people.1 Especially

beginning in adolescence

keratoconus much faster

has been shown to progress.2

Keratoconus is primarily caused by the eyeball.

extracellular collagen that maintains its normal shape

biomechanically of fibers

caused by the deterioration

is considered. In fact, this early stage is a

subclinical condition and keratoconus

mostly until it gives clinical signs, that is, moderate.

and treatment until advanced levels

3

mild or moderate

treatment in patients with keratoconus

The approach is conservative and non-invasive. This

treatment, the cause of the deformed cornea

visual disturbances, mild to moderate

to correct graded keratoconus

specially designed soft hydrogel,

hybrid (hard center with a soft surround)

or with scleral (extra-large) lenses

is being corrected. moderately advanced

eyes with keratoconus, special for 4.5 patients

also with enhanced prosthetic scleral lenses

can be rehabilitated. Cornea

opacity, excessive apical thinning

patients with advanced keratoconus

Penetrating Keratoplasty (PKP) or Deep

such as Anterior Lamellar Corneal Transplant (DALK)

tissue rejection, acute or chronic severe

much greater risk of complications.

invasive surgical methods

6,7

Today, with technological advances

combined with residual conductive keratoplasty, corneal

collagen cross-linking (CXL), intra-corneal

corneal reshaping as ring (ICR)

in addition to the procedures

enhancing new generation folding intraocular lens

implantations are less invasive and permanentas surgical methods

implemented.8,9

Topography-accompanied conductive

keratoplasty, smaller on the corneal surface

smoothing out irregularities and smoothing the eye surface

It is preferable to reshape

is a method. CXL alone or more

corneal tissue in advanced stages

other, such as the ICR, to strengthen

together with the methods

10,11 ICRs, eye

rebuild the front surface of the sphere

surgically into the cornea to shape

placed, restoring visual acuity

to ensure that the light is gained from the center and

on the cornea to allow

a surface by applying a smoothing force

spring-shaped, stabilizing

12 In fact, CXL is a weak structure.

reinforced with concrete columns, ICR

On the other hand, the same weak structure is more difficult with iron profiles.

can also be compared to strengthening. CXL and

Next generation implantable ICRs

folding Collamer® lenses (ICLs) or

multifocal foldable posterior chamber intraocular

vision by adding lenses (PCIOLs)

can be further corrected.

In this study, ICR placed advanced

CXL helpful with patients with stage keratoconus

with or without CXL

then phakic selected according to appropriate criteria.

or pseudophakic PCIOL implantation

7 years of experience of patients who applied

comparison with the results.

Method

Study design and patients

The study was submitted to the World Eye Adana Clinic.

For 7 years (January 2011–January 2018)

presenting with advanced keratoconus

surgery out of a total of 1922 patients diagnosed

1068 (55.6%) patients who accepted the treatment

covers. refusing treatment

all patients due to treatment costs

reported that they could not continue the treatment.

Diagnosis of patients with keratoconus;

refraction, biomicroscopy, vision

examination and corneal topography.

evaluated and graded. 1068

2136 eyes of the patient were keratoconus, 648 of them

male (60.7%), 420 female (39.3%) and age

the mean was 30.7±8.6 years.

For staging of keratoconus

various keratoconus grades and classification

schemes are used. historical value and

in terms of prevalence, astigmatism, cornea

strength, corneal transparency and corneal

based on the thickness and stages I, II, III, IV.

The Amsler-Krumeich rubric describing

scaling is one of the best known.

In our clinic, anterior and posterior curvature

fine pachymetry values ​​and distance

waist, which includes visual acuity, and

Updated by Duncan[13]

keratoconus ABCD staging assessment

we use the table of five phases here

in question (0–4). ABCD system, front

Amsler-Krumeich in relation to curvature

shows good compatibility with the system,

but the anatomical features seen in keratoconus

reflects changes better because apical

based on the finest point rather than measurements

back curvature and thickness measurements

contains.

Of 2136 operated eyes;

Stage 3 in 939 (44%) and 1197 (56%)

stage 4 keratoconus was determined.

Belin as an evaluation criterion and

Duncan ABCD rating system

13 Auxiliary CXL thin

corneal scar development in and but not in the corneas

enough cornea to not pose a risk

It is recommended for patients with thick thickness.14

Foldable next-generation ICLs or

foldable multifocal next generation PCIOLs

choice of implantation; residual refraction

error and after ICR implantation

UCVA (uncorrected visual acuity) and

CDVA (corrected visual acuity)

made according to the difference between For ICL selection

criteria an anterior chamber depth of ≥ 3 mm,

a white to white ≥ 11.2 mm cornea

diameter and a cornea of ​​K max ≥ 55 mm

determined as curvature.

Foldable next generation PCIOL

(i) Patients over 40 years of age

(due to presbyopia and possible cataract), (ii)

young people with insufficient anterior chamber depth

patients and (iii) smaller eyes were selected.

The protocol of the presented study,

It was approved by the Ethics Committee of the World Eye Foundation.