title: One-year results of intrastromal corneal ring segment implantation (KeraRing) using femtosecond laser in patients with keratoconus.
abstract: OBJECTIVE
  To report the results of intrastromal corneal ring segment [ICRS] (KeraRing; Mediphacos, Belo Horizonte, Brazil) implantation using a femtosecond laser (IntraLase Corp, Irvine, California, USA) in keratoconic patients.
  
  
  METHODS
  Retrospective, noncomparative, interventional study.
  
  
  METHODS
  Thirty-two keratoconic patients (50 eyes) who underwent ICRS insertion using a femtosecond laser for channel creation and completed at least one year of follow-up were included in this study. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, topographic findings, and adverse events were assessed.
  
  
  RESULTS
  No intraoperative complications were demonstrated in this series of patients. At the first postoperative day, segment migration to the incision site was seen in three eyes (6%; early postoperative complication). To avoid melting, we repositioned the migrated segment away from the incision site. Serious second migration was not seen and we did not need to reposition any segment again. At the last postoperative examination, there was a statistically significant reduction in the spherical equivalent refractive error compared with that observed at the examination before implantation (mean +/- standard deviation, -5.62 +/- 4.15 diopters [D; range, -23.62 to 0.50 D] to -2.49 +/- 2.68 D [range, -11.12 to 3.5 D]; P < .001). The UCVA before implantation was 20/40 or worse in 47 eyes (94%; range, counting fingers to 20/30), whereas at the last follow-up examination, 14 (28%) of 50 eyes had a UCVA of 20/40 or better (range, counting fingers to 20/25). Nine eyes (18%) maintained the preimplantation BSCVA, whereas 39 eyes (68%) experienced a BSCVA gain of one to four lines at the last follow-up examination. Only in two eyes (4%; two patients) with advanced keratoconus (stage III) was there a decrease of up to two lines. Despite this deterioration in BSCVA, the patients did not want to remove the ICRSs, because there was an increase of UCVA. No late postoperative complications were observed during the follow-up period.
  
  
  CONCLUSIONS
  ICRS (KeraRing) implantation using femtosecond laser for tunnel creation is a minimally invasive procedure for improving visual acuity (both UCVA and BSCVA) in keratoconic patients.
authors.affiliation: Dunya Eye Hospital, Istanbul, Turkey.
authors.forename: Efekan
authors.initials: E
authors.lastname: Coskunseven
authors.forename: George D
authors.initials: GD
authors.lastname: Kymionis
authors.forename: Nikolaos S
authors.initials: NS
authors.lastname: Tsiklis
authors.forename: Serife
authors.initials: S
authors.lastname: Atun
authors.forename: Ebru
authors.initials: E
authors.lastname: Arslan
authors.forename: Mirko R
authors.initials: MR
authors.lastname: Jankov
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Pallikaris
mesh_terms: D000293:Adolescent; D000328:Adult; D003319:Corneal Stroma / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications; D011379:Prognosis; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012029:Refraction, Ocular; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology
chemical_list: D019904:Polymethyl Methacrylate