Dr. Coşkunseven "Combination of Keraring and Toric phakic implantable collamer lens for...
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COMBINATION OF KERARING AND T ORIC PHAKIC IMPLANTABLE COLLAMER LENS FOR KERATOCONUS Efekan Coskunseven, MD Dünya Göz / World Eye Hospital, Istanbul, Turkey Keraring User Meeting ESCRS LONDON 2014.
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Dr. Dr. Coşkunseven presentation at the Total Keratoconus Solution user meeting organized by Mediphacos: "Combination of Keraring and Toric phakic implantable collamer lens for keratoconus" 2014 ESCRS, London
Transcript of Dr. Coşkunseven "Combination of Keraring and Toric phakic implantable collamer lens for...
COMBINATION OF KERARING AND TORIC
PHAKIC IMPLANTABLE COLLAMER
LENS FOR KERATOCONUS
Efekan Coskunseven, MDDünya Göz / World Eye Hospital, Istanbul, Turkey
Keraring User Meeting
ESCRS LONDON
2014.
COMBINED TREATMENT OPTIONS
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+
+ +
0.63
0.82
0.87 0.88 0.89 0.89
0.3
0.4
0.79
0.830.85
0.88
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Pre corsslinking Pre ICL After 7 days After 1month After 3months After 6months After 1year
BSCVA UCVA
BSCVA & UCVA
0.56
0.88
METHODS
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Stop Progression
<1,5D IrregularitySph<-18 D
Cyl<5 D
COMBINED TREATMENT OPTIONS
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+ +
TORIC ICL IMPLANTATION AFTER
INTRACORNEAL RING IMPLANTATION FOLLOWED
BY CORNEAL COLLAGEN CROSSLINKING FOR
THE TREATMENT OF KERATOCONUS
+ +
J Cataract Refract Surg. 2013 Mar 13. doi:pii: S0886-
3350(13)00003-5. 10.1016/j.jcrs.2012.11.027
METHODS 14 eyes of 9 patients with keratoconus
ICLToric implantation after Intracorneal Ring Segment Implantation
followed by CXL (ICR+CXL).
7 M 8,4 M
•The Mean interval between ICR and CXL was 7 months and the mean
interval between CXL and ICLToric implantation was 6,4 months.
•The preoperative and postoperative visual acuity, refraction,
pachymetry and topography results were evaluated.
•The mean follow-up period was 7.2 months.
METHODS
Channel creation
(INTRALASE FS 60): 15
seconds.
Depth adjusted to 80% of
the thinnest point at
tunnel location.
Corneal incision : at
steep axis.
Keraring:4.4-5.6 mm
+ +
ICL operations were
performed 8,4 months
after CCL
ICL calculation was
based on post op
ICR+CXL refraction
ACD> 2,8 mm
0,1% B2 in 20%
Dextran T-500 30 min
UV (Peschkemed)
370 nm 3 mW/cm² for
30 min
ICL operations were
performed 8,4 months
after CCL
MOST DIFFICULT ;
ICL calculation was
based on post op
ICR+CXL refraction
ACD> 2,8 mm
UCVA BCVA
Pre-Op 0,01 0,16
Post-ICR 0,06 0,46
Post-ICR+CCL 0,08 0,48
Post-ICL 0,46 0,58
0
0.1
0.2
0.3
0.4
0.5
0.6
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
0.01
0.060.08
0.46
0.16
0.460.48
0.58
UCVA & BCVA
UCVA BCVA
CYL SEQ
Pre-Op -4,73 -16,4Post-ICR -2,36 -9,81Post-ICR+CCL -1,88 -9,56Post-ICL -0,96 -0,8
-18
-16
-14
-12
-10
-8
-6
-4
-2
0Pre-OP Post-ICR Post-ICR+CXL Post-ICL
-4.73
-2.36 -1.88 -0.96
-16.4
-9.81 -9.56
-0.8
CYLINDER & SEQ
CYL SEQ
Mean K
Pre-Op 58,36Post-ICR 55,77Post-ICR+CCL 54,07Post-ICL 54,03
58,36
55,77
54.07 54.03
51
52
53
54
55
56
57
58
59
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
Mean K
K1
Pre-Op 56,16
Post-ICR 54,78
Post-ICR+CCL 53,54
Post-ICL 53,57
56,16
54,78
53.54 53.57
52
53
54
55
56
57
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
K1
56,1-54,7=1,4 D
K2
Pre-Op 60,57
Post-ICR 56,76
Post-ICR+CCL 54,61
Post-ICL 54,48
60,57
56,76
54.61 54.48
50
52
54
56
58
60
62
Pre-OP Post-ICR Post-ICR+CXL Post-ICL
K2
60,5-56,7=3,8 D60,57-56,76=-3,81D
METHODS
7 M 8,4 M
<7 D
IrregularitySph<-18 D
Cyl<5 D
Stop Progression
<1,5D
Irregularity
CONCLUSION
Topo-Guided Transepithelial PRK ,Toric Phakic IOL
Implantation , ICR implantation followed by CXL is
an effective treatment sequence that can stop
progression and improve vision and refraction in
select keratoconus patients
However a long-term follow-up of a larger
population study is required to validate these
findings
THANK [email protected]
