Bandage Therapeutic-Optical Keratoplasty in Keratoconus Patients after Intrastromal Corneal Segments Implantation

Purpose — to evaluate the functional results of bandage therapeutic-optical keratoplasty (BTOK) in keratoconus eyes after implantation of intrastromal corneal ring segments (CRS). Material and methods. The study included 18 patients with stage II and III keratoconus (as per Amsler-Krumeich classification) who had underwent implantation of CRS with unsatisfactory long-term outcomes. The patients were divided into two groups. The first group consisted of 7 patients (7 eyes) of 27 ± 3 years old with had past history of CRS implantation followed by the absence of predicted improvement of visual acuity during the observation period of up to 18 months. The second group included 11 patients (11 eyes) who had visual acuity improvements after CRS implantation, but had regression in the long-term follow-up of 2 to 5 years. The surgical algorithm consisted of two steps: first, all 18 patients had the intrastromal ring segments removed; second, 3 months later they underwent BTOK. Outcomes. After the removal of CRS, patients of both groups showed improvements in central corneal refraction, their visual acuity decreased to 0.07 ± 0.02 and 0.09 ± 0.04, respectively. The 36 months follow-up after BTOK revealed significant improvements in visual acuity — up to 0.48 ± 0.04 and 0.54 ± 0.11, respectively — in all patients in both group due to marked flattening of the cornea in the optical zone. Conclusion. Bandage therapeutic-optical keratoplasty allows treatment of patients with complicated or who had unsatisfactory results after implantation of intrastromal ring segments. The surgery leads to stabilization of keratectasia in keratoconus patients and significantly increases uncorrected visual acuity.

1. Аветисов С.Э., Карамян А.А., Юсеф Ю.Н., Егорова Г.Б., Махмуд М.И., Оси пян Г.А. Имплантация интрастромальных роговичных сегментов при керато конусе. Вестник офтальмологии. 2012;128(6):20–24. [Avetisov S.E., Karamyan A.A., Yusef Yu.N., Egorova G.B., Mahmoud M.I., Osipyan G.A. Implantation of in trastromalny corneal segments at keratoconus. Annals of Ophthalmology = Vestnik oftal’mologii. 2012;128(6):20–24 (In Russ.)].

2. Colin J., Cochener B., Savary G., Malet F., Holmes-Higgin D. Intacs inserts for treating keratoconus: one-year results. Ophthalmology. 2001;108(8):1409–1414.

3. Alio J.L., Artola A., Hassanein A., Haroun H., Galal A. One or 2 intacs segments for the correction of keratoconusj. Cataract. Refract. Surg. 2005;31(5):943–953. DOI: 10.1016/j.jcrs.2004.09.050

4. Alio J.L., Shabayek M.H. Intracorneal asymmetrical rings for keratoconus: where should the thicker segment be implanted. J. Refract. Surg. 2006;22(3):307–309.

5. Alio J.L., Shabayek M.H., Belda J.I., Correas P., Feijoo E.D. Analysis of results related to good and bad outcomes of intacs i0mplantation for keratoconus correction. J. Cataract. Refrakt. Surg. 2006;32(5):756–761. DOI: 10.1016/j.jcrs.2006.02.012

6. Cosar C.B., Sridhar M.S., Sener B. Late onset of deep corneal vascularization: a rare complication of intrastromalcorneal ring segments for keratoconus. Eur J Ophthalmol. 2009;2:298–300.

7. Ibáñez-Alperte J., Pérez-García D., Cristóbal J.A., Mateo A.J., Río B.J., Mínguez E. Ker atitis after Implantation of Intrastromal Corneal Rings with Spontaneous Extrusion of the Segment. Case Report. Ophthalmol. 2010;2:42–46. DOI: 10.1159/000320585

8. Kymiomis G.D. Long-term follow-up of Intacs in keratoconus. Am. J.Ophthalmol. 2007;143:236–244. DOI: 10.1016/j.ajo.2006.10.041

9. Martin R.G. Wedge resection in the cone after failed refractive surgery in patient with keratoconus. J. Refract. Surg. 1995;21(3):348–350.195. DOI: 10.1016/S08863350(13)80145-9

10. Бикбов М.М., Бикбова Г.М., Исхакова А.Х. Результаты имплантации интра стромальных роговичных сегментов (Keraring) при кератоконусе. Офтальмохирургия. 2013;2:55–58. [Bikbov M.M., Bikbova G.M., Iskhakova A.H. The re sults of the intrastromal corneal segments (Keraring) implantation in keratoconus. Ophthalmosurgery = Oftal’mokhirurgiya. 2013;2:55–58 (In Russ.)].

11. Torquetti L., Ferrara G., Almeida F., Cunha L., Araujo L.P., Machado A., Marcelo Lyra J., Merayo-Lloves J., Ferrara P. Intrastromal corneal ring segments implantation in patients with keratoconus: 10-year follow-up. J Refract Surg. 2014 Jan;30(1):22– 26. DOI: 10.18240/ijo.2016.09.08

12. Pesando P.M., Ghiringhello M.P., Di Meglio G., Romeo S. Treatment of keratoconus with Ferrara ICRS and consideration of the efficacy of the Ferrara nomogram in a 5-year follow-up. Eur J Ophthalmol. 2010 Sep-Oct;20(5):865–873.

13. Beniz L.A., Queiroz G.H., Queiroz C.F., Lopes W.L., Moraes L.F., Beniz J. Intrastromal corneal ring segments delay corneal grafting in patients with keratoconus. Arq Bras Oftalmol. 2016 Feb;79(1):30–32. DOI: 10.5935/0004-2749.20160009

14. Chhadva P., Yesilirmak N., Cabot F., Yoo S.H. Intrastromal Corneal Ring Seg ment Explantation in Patients With Keratoconus: Causes, Technique, and Outcomes. J Refract Surg. 2015 Jun;31(6):392–397. DOI: 10.3928/1081597X20150521-05

15. Vega-Estrada A., Alió J.L., Plaza-Puche A.B. Keratoconus progression after intrastromal corneal ring segment implantation in young patients: Five-year follow-up. J Cataract Refract Surg. 2015 Jun;41(6):1145–1152. DOI: 10.1016/j.jcrs.2014.08.045

16. Мороз З.И., Леонтьева Г. Д., Новиков С. В., Гурбанов Р.С. Рефракционные ре зультаты имплантации интрастромальных роговичных сегментов на основе гидрогеля у пациентов с кератоконусом. Офтальмохирургия. 2009;1:14–17. [Moroz Z.I., Leontieva G.D., Novikov S.V., Gurbanov R.S. Refractive Results of Implantation of Intrastromal Hydrogel Corneal Segments in Keratoconus Patients. Ophthalmosurgery = Oftal’mokhirurgiya. 2009;1:14–17. (In Russ.)].

17. Torquetti L., Ferrara G., Almeida F., Cunha L., Ferrara P., Merayo-Lloves J. Clinical outcomes after intrastromal corneal ring segments reoperation in keratoconus patients. Int J Ophthalmol. 2013 Dec 18;6(6):796–800. DOI: 10.3980/j.issn.22223959.2013.06.10

18. Мамиконян В.Р., Аветисов С.Э., Осипян Г.А., Егорова Г.Б., Догузов В.А., Ми тичкина Т.С. Интерламеллярная бандажная кератопластика для лечения прогрессирующего кератоконуса (предварительное сообщение). Вестник офтальмологии. 2015;131(1):18–23. [Mamikonyan V.R., Avetisov S.E., Osipyan G.A., Egorova G.B., Doguzov V.A., Mitichkina T.S. Intralamellar bandage keratoplasty for the treatment of progressive keratoconus (draft report). Annals of Ophthal mology = Vestnik oftal’mologii. 2015;131(1):18–23 (In Russ.)]. DOI: 10.17116/ oftalma2015131118-23