Further follow-up is required to determine whether these techniques are comparable in the long-term. Written By: Yan Nuzbrokh, BS, Eric Rosenberg, MD, and Alanna Nattis, MD Edited By: Bennie H. Jeng, MD Read Article. Statistically significant differences were found in the relative position of the refractive axis and keratometric axis (P=.017). Correlations and a binary logistic regression were established. (best spectacle-corrected visual acuity (BSCVA) ≤ 0.05 logMAR) and keratoconus patients with V.L. Keratoconus is a non-inflammatory eye condition in which the normally round dome-shaped clear window of the eye (cornea) progressively thins causing a cone-like bulge to develop. Conclusions: Keratoconus management is easy as long as you are working with a good eye care doctor. The posterior apex deviation variable shows the best keratoconus diagnosis capability. (Graft Presented). ... 40 Refractive management of keratoconus patients is also well covered. No patient lost lines of CDVA. Purpose: To report early results of combined accelerated corneal collagen crosslinking (CXL) and intrastromal Kerarings implantation by femtosecond laser in a case of advanced superior keratoconus.Methods: The patient was a 27-year-old male with left eye grade 3 keratoconus with superior cone. Purpose: To improve the predictability of the visual and refractive outcomes of intrastromal corneal ring segment (ICRS) implantation in keratoconus patients and highlight the importance of internal astigmatism and its relationship to corneal and refractive astigmatism as prognostic factors. Intrastromal Kerarings implantation by femtosecond laser was carried out by IntraLase (iFS, Abbott) along with accelerated transepithelial corneal collagen crosslinking by KXL system (Avedro, USA) in the same session. We did not observe significant differences between preoperative and 12-month postoperative readings in within-group analysis: ΔKmax (TE-ACXL, -2.13±5.41, P=0.25 vs C-CXL, 0.78±1.65, P=0.17), Δpachymetry (TE-ACXL, 4.10±14.83, P=0.41 vs C-CXL, -8.90±22.09, P=0.24), ΔISV (TE-ACXL, -8.50±21.26, P=0.24 vs C-CXL, 3.80±12.43, P=0.36), ΔIVA (TE-ACXL, -0.12±0.31, P=0.26 vs C-CXL, 0.03±0.18, P=0.61), and ΔIHD (TE-ACXL, -0.03±0.07, P=0.18 vs C-CXL, -0.01±0.03, P=0.88). The mean spherical equivalent was -9.31 diopters (D) ± 4.20 (SD) (range -20.75 to -2.75) preoperatively and -0.46 ± 0.88 D (range -3.25 to 1.00 D) postoperatively (P<.001). Five-millimeter corneal stripes were prepared and biomechanical stiffness was measured using an extensometer. Our experience shows that it is a safe technique (1. topography-guided PRK followed by corneal collagen cross-linking for keratoconus. A cross-sectional study was carried out in Torrecárdenas Hospital, Almería, Spain, between February 2018 and July 2019. 4.4. ModicationstotheStandardProcedure, of the CXL complications: pain, delays in epithelium regeneration, infection, haze, corneal melti, would enable the corneal epithelium to remain i, keratoconus have a corneal thickness of less t, 4.5. after CXL. J Refract Surg 2009 Sep;25(9):S807-S811. Eyes of patients with progressive keratoconus who were treated with C-CXL (3 mW/cm2 for 30 minutes) were compared with those who underwent TE-ACXL (6 mW/cm2 for 15 minutes). There was no endothelial damage in the 6 rabbit eyes enucleated at 4 hours. COLUMN ARTICLE Ahmed AK Elmassry Alexandria University Egypt “The key point in the success of treat-ment of Keratoconus is early Diagnosis ” … The possibility of a secondary infection after the procedure exists because the patient is subject to epithelial debridement and the application of a soft contact lens. Keratoconus Management A structured approach to treating and billing. View; Mark Complete; Remove; Comments. The application of the PCA with Varimax rotation offered a total of five factors which explains the 85.51% of the total variability. 59. In Keratoconus there is progressive thinning of the cornea and as a result the cornea develops a cone-like bulge and becomes distorted. The mean efficacy index was not statistically different between the PC pIOL (0.88 ± 0.28) and the iris-claw pIOL (0.96 ± 0.22) (P=.058). Am J Ophthalmol 2003;135(1):64-70. In eyes with normal CDVA, those factors related to the nonorthogonal shape irregularity of the cornea and the refractive power are the ones that showed more discriminating capabilities between normal and early keratoconic eyes. The aim of this study is to describe a new keratoconus detection method based on the analysis of certain parametric morphogeometric operators extracted from a custom patient-specific three-dimensional (3D) model of the human cornea. The purpose of this review is to provide evidence-based clinical practice guidelines (CPG) in the management of patients with keratoconus with RGP CLs. Recent findings During the asymmetric progression of the disease, the current diagnostic indexes do not record the geometric decompensation of the corneal curvature nor the variation of the spatial profile that occurs in singular points of the cornea. BERGMANSON, OD, PHD, PHD HC, DSC, & JESUS MARTINEZ, OD K eratoconus is a peculiar and fascinating corneal disease in which the cornea weakens biomechanically, sheds tissue, and scars. Porcine corneas were treated with an epithelium-off CXL at a fluence of 9 mW/cm(2) under two different atmospheres: one with a regular oxygen content (21%) and another in a helium-supplemented, low-oxygen environment (<0.1%). First, it mentions the disease and its diagnostic tools with the related clinical interpretation. By Deepak Gupta, O.D., Stamford, Conn. Optometrists are often the first to see keratoconic patients, and we're the best qualified to serve their primary eyecare needs. Written By: Yan Nuzbrokh, BS, Eric Rosenberg, MD, and Alanna Nattis, MD Edited By: Bennie H. Jeng, MD Read Article. Ultrasound pachymetry can also be used to measure the thinnest zone on the cornea. Advantages and Disadvantages of Intracorneal Segment Implants, A multicenter study conducted by our researc, Success was dened as cases that had the following c. Meanwhile, failure criteria were as follows: With regard to uncorrected distance visua, benet from ICRS implants are those who have the greatest visual i, 6. By Clark Y. Chang, OD, MSA, MSC, FAAO; Christopher J. Rapuano, MD. The mean spherical equivalent was -9.31 diopters (D) ± 4.20 (SD) (range -20.75 to -2.75) preoperatively and -0.46 ± 0.88 D (range -3.25 to 1.00 D) postoperatively (P<.001). June 1, 2001. -Customization should be done for every patient in keratoconus management. The mean decimal UDVA was 0.08 ± 0.09 preoperatively and 0.71 ± 0.26 postoperatively and the mean decimal CDVA, 0.77 ± 0.24 and 0.87 ± 0.98, respectively (P<.001). Third, it builds up a mesh in a flow chart manner and suggests a check list together with a three-step approach. 2019 Aug 1;35(8):478-483. doi: 10.3928/1081597X-20190627-01. greatest optical power both in the anterior and posterior, as a reference, improves the information of the posterior surface in rel, the aberrations induced by the optical surface crossed. -Age is a guiding factor in treatment with aggressive attitude in young age. An update. Our survey provides a basic snapshot of current, local practice. as the dependent variable and spherical equivalent, HOARMS, spherical aberration and interaction between the anterior and posterior vertical coma as independent variables. The mean decimal UDVA was 0.08 ± 0.09 preoperatively and 0.71 ± 0.26 postoperatively and the mean decimal CDVA, 0.77 ± 0.24 and 0.87 ± 0.98, respectively (P<.001). It is important to note that doctors strongly advise patients experiencing any level of keratoconus to avoid rubbing their eyes. (BSCVA > 0.05 logMAR). Keratoconus Keratoconus Management A structured approach to treating and billing. By Deepak Gupta, O.D., Stamford, Conn. Optometrists are often the first to see keratoconic patients, and we're the best qualified to serve their primary eyecare needs. PDF of Article. Clinical Management Guidelines. To discuss and summarize the indications, contraindications and results in refractive surgery for keratoconus. corneal collagen cross-linking performed in a single combined procedure for the treatment of keratoconus and pellucid marginal. INDICATIONS OF INTRACORNEAL RING SEGMENTS, because of their ability to reshape the corneal surface, they can be quite ineffective in advanced grades. curve was 0.924, sensitivity 91.90%, specificity 83.60%, accuracy 88.94%; and precision 91.17%. Semisoft or RGP or Rose K contact lens, can help in cases with mild to moderate keratoconus. Conclusions. Additionally, ophthalmology should continue to work with optometry to develop guidelines for referral and co-management to optimise future … DUCTION: WHAT WE UNDERSTAND BY KERATOCONUS? Alio JL, Sanz-Díez P. Phakic Intraocular Lenses in Keratoconus. Multicentric, comparative study including a total of 995 eyes and divided into two groups: 625 eyes suffering from early keratoconus but with normal vision [spectacle corrected distance visual acuity (CDVA) of 0.9 decimal or better] and 370 normal control eyes with same normal vision level. An iris-claw (Artiflex) or collagen copolymer posterior chamber pIOL (PC pIOL) (Implantable Collamer Lens) was implanted in eyes with stable keratoconus. To assess the diagnostic ability of Pentacam HR (Oculus Optikgeräte, GmbH, Wetzlar, Germany) tomographic indices in discriminating keratoconus (KC) and KC suspect (KCS) in 10- to 30-year-old patients with Down syndrome (DS). Dr.Yajuvendra S Rathore KERATOCONUS 2. No patient lost lines of CDVA. Some of the common established criteria for keratoconus progression that have been used in decision-tree and classification schemes are listed in Established Criteria for Keratoconus Progression. A spherical surface corresponds to SAI = 0. However, it is associated wi We, therefore, invite researchers to submit original research and review articles on cutting-edge technologies that will contribute to the diagnosis and management of keratoconus. Keratoconus is a non-inflammatory, progressive thinning process of the cornea. Methods: We can … Dr. Mohd Najmussadiq Khan 2. Two groups were created according to a grading system of V.L. Br J Ophthalmol 2011; 95:1044. This comparative study included 80 eyes of patients classified as mild KC according to the degree of visual limitation and a control group of 122 eyes of normal patients. Conclusion This article extensively describes the differences of the various types of contact lenses, which may be used for visual rehabilitation of these patients. No author has a financial or proprietary interest in any material or method mentioned. An update. It is also an effective operation (post-UDVA/pre-CDVA = 0.90 ± 0.26). This paper aims to calculate a relevance model of visual limitation (V.L.) Purpose. Keratoconus significantly impacts upon the life of patients suffering from this frustrating disease. Retrospective case series. The guidelines provide evidence-based, clinical advice for the management of different aspects of RVO. to the formation of the new collagen bonds. The terminal deoxynulceotidyl transferase deoxy-UTP-nick-end labeling (TUNEL) technique and transmission electron microscopy were used to detect apoptosis. Few cases of co-management with ophthalmologists were noted (no co-management reported by 60.3% in the UK and 72.8% in Spain, p = 0.01). According to the Rabinowitz classication. Nevertheless, each treatment modality has its own indications, conditions, contra-indications and complications. Listing a study does not mean it has been evaluated by the U.S. Federal Government. This V.L. Eye (Lond) 2004; 18:379. The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care. EC Ophthalmology ECO.01 (2016): 01. Therefore, it is a way of assessi, the more likely it is that the cornea has a morpho, Simulated keratometry (Sim K): as previously d. corneal power and the number of points considered. Background: Keratoconus (KC) causes visual disability in young adults. The two primary lines of action, To evaluate the visual and refractive outcomes, predictability, and stability of phakic intraocular lens (pIOL) implantation in keratoconic eyes and compare the results of 2 pIOL models. The relationship between topographic astigmatism and refractive astigmatism was evaluated. Purpose: This project aimed to reach consensus of ophthalmology experts from around the world regarding keratoconus and ectatic diseases, focusing on their definition, concepts, clinical management, and surgical treatments. … Keratoconus can be diagnosed through a routine eye exam.Your ophthalmologist will examine your cornea, and may measure its curvature.This helps show if there is a change in its shape. Treatment mainly included strategies to improve visual acuity (eg, rigid contact lens, corneal rings, and penetrating keratoplasty), and none of them could alter the natural history of the disease. Sphere changed from -1.77±6.57D (-11.00 to 7.00) preoperatively to 0.08±0.79D (-1.25 to 1.75) postoperatively (p=0.211), and cylinder changed from -2.95±1.71D (-7.00 to -0.75) to -1.40±1.13D (-3.25 to 0.00) (p=0.016). Keratoconus (ker-uh-toe-KOH-nus) occurs when your cornea — the clear, dome-shaped front surface of your eye — thins and gradually bulges outward into a cone shape.A cone-shaped cornea causes blurred vision and may cause sensitivity to light and glare. Th, components to the magnitude of these parameters a, 5.3. “A simplified Guidelines for Management of Patients with Keratoconus”. Attendees will learn several surgical techniques to control this pathology and how to apply these techniques in their clinical practice. Best-corrected visual acuity (BCVA), keratometry values, corneal thickness, and topometric indexes were compared before CXL, and at 2 months, 6 months, and 12 months postoperatively. J Refract Surg 2009 Sep;25(9):S812-S818. Although this lacks high sensitivity or specicity in the diagnosis of keratocon, spaced meridians. The treatment strategy of keratoconus in general mainly includes strategies to improve visual acuity as rigid contact lens, corneal rings, penetrating keratoplasty and corneal collagen crosslinking, which is the only procedure that may slow down or stop keratoconus progression. classication establishes the following g, *RMS: root mean square. The main outcome measures were postoperative changes from the preoperative manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography, and endothelial cell count. Phakic IOL implantation is a suitable refractive surgical option for stable keratoconus. Int Ophthalmol 2012 Oct;32(5):423-429. verisysephakic intraocular lens for refractive improvement in keratectasia. He was diagnosed by Sirius Scheimpflug corneal topography (CSO, Florence, Italy). We present this keratoconus management guideline in order to provide an update on the aims and indications of the various therapies used to treat keratoconus. Keratoconus Management in Patients with Contact Lenses, sight and the apex of the cone is not too steep. UDVA (logMAR) changed from 1.33±0.95 (0.40 to 2.77) to 0.32±0.38 (0.00 to 1.30) (p=0.008) and CDVA (logMAR) changed from 0.32±0.45 (0.01 to 1.77) to 0.20±0.36 (-0.03 to 1.30) (p=0.013). In the very early stages, spectacles lenses are an option, especially for patients who achieve 20/40 or better vision with spectacles. The posterior corneal surface is later analysed using an optimised computational geometry technique and the morphology of healthy and keratoconic corneas is characterized by means of geometric variables. This dependency will be of particular importance in high-fluence and transepithelial CXL and will most likely require major protocol modifications to maintain the efficiency of the method. J Refract Surg 2009 Sep;25(9):S812–S818. This new custom computational approach provides the clinician with a three-dimensional view of the corneal architecture when the visual loss starts to impair. was seen to resemble preoperative values 1 month post CXL. Save page Share Aetiology. The refractive surgery in keratoconus has been discussed by several authors. A corneal geometric reconstruction is firstly performed using zonal functions and retrospective Scheimpflug tomography data from 107 eyes of 107 patients. Add to My Bookmarks. Keratoconus is a non‐inflammatory corneal ectasia … Semisoft or RGP or Rose K contact lens, can help in cases with mild to moderate keratoconus. Summary -Pentacam is an important tool in evaluation of Keratoconus patient. Date: 27/08/2019 Venue: Bakehouse Garden, Shop 4, 9-11 George Street, North Strathfield, NSW, 2137 Provider: Cornea & Contact Lens Society of Australia Contact: Margaret Lam / Shaheera Survery Patterson, [E] info@cclsa.org.au, [P] 02 9431 8676 Learning Objectives. To improve its early detection and compliance, improving the awareness of patients and their relatives is crucial. The management of keratoconus depends on the state of progression of the disease. Diagnosis and Management of Keratoconus. Area under the curve (A.U.C.) We can fit them with glasses or contact lenses, or refer them for surgery. The most prominent correlation was found between the anterior and posterior deviations of the thinnest point for the mild keratoconic cases. In pictorial quality with a good eye care doctor ectatic disease, and were. ; 27 ( 9 ): S807-S811 non-inflammatory, bilateral ( but usually asymmetrical ) disease the... 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Permeable contact lenses provide better correction in such cases about the effectiveness of and...