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Sequential Vs concurrent Kera rings & CXL for keratoconus

Sequential Vs concurrent Kera rings & CXL for keratoconus. Tamer M. El-Raggal, MD, PhD, FRCSEd Associate Professor of Ophthalmology Ain Shams University. The author have no financial interest in subject matter of this poster. Introduction.

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Sequential Vs concurrent Kera rings & CXL for keratoconus

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  1. Sequential Vs concurrent Kera rings & CXL for keratoconus Tamer M. El-Raggal, MD, PhD, FRCSEd Associate Professor of Ophthalmology Ain Shams University The author have no financial interest in subject matter of this poster

  2. Introduction • KC might be aggressive corneal insult, especially in young. Correction - Glasses - CL - CXL - ICRS -P IOL - ALK - PKP El-Raggal, T WCC VI, 2010

  3. Technique CXL consists of photopolymerization of stromal fibres by combined action of photosensitizing substance (riboflavin) & UVA. • This increases rigidity of corneal collagen. • ICRS act by an “arc-shortening effect” on corneal lamellae & flatten central cornea. • Main advantage is that it does not affect the visual axis. El-Raggal, T WCC VI, 2010

  4. Aim of the Study • To evaluate safety, efficacy..... • To compare refractive outcomes ….. of combined ICR (Kera rings) & CXL performed in1 or 2 sessions. El-Raggal, T WCC VI, 2010

  5. Patients Inclusion criteria • Progressive KC • CL intolerance. • Clear cornea (no apical scarring). • K < 60 D. • Thickness > 400 u. 16 eyes of 10 patients (6 ♀ & 4 ♂) • Age 22 - 36 yrs (27.9 ± 4.8 yrs) • UDVA 0.05 - 0.3 (0.13 ± 0.07) • CDVA 0.2 - 0.5 (0.34 ± 0.12) • Spherical error -1.50 - -7.0 D (-4.06 ± 1.51) • Cylindrical error 3.75- 6.50 D (5.36 ± 0.86 D) El-Raggal, T WCC VI, 2010

  6. Methods • Group 19 eyes ---- Kera insertion followed by CXL 6m. • Group 27 eyes ---- 2 procedures same session. • In both groups channel creation performed using femtosecond laser(Intralase F60). El-Raggal, T WCC VI, 2010

  7. Group 2 Results Visual Acuity Group 1 • No significant difference between 2 groups regarding changes in UDVA, CDVA El-Raggal, T WCC VI, 2010

  8. Group 2 Results Refractive Error Group 1 • No significant difference between 2 groups regarding changes in refractive error El-Raggal, T WCC VI, 2010

  9. Group 2 Results Keratometry Group 1 • However, group 2 revealed more significant reduction of K readings. • Stromal haze developed was more marked & persistant in group 2 → resolved without sequelae. El-Raggal, T WCC VI, 2010

  10. Group 1 K: 53.89/ 47.51 K: 49.37/ 44.10 Topography K: 53.95/ 51.66 K: 47.42/ 43.02 Group 2 El-Raggal, T WCC VI, 2010

  11. Discussion • CXL leads to mean of 2.00D flattening. Implantation of ICRS is another modality useful in mechanically flattening cone. • Based on these, combined ICRS & CXR leads to synergistic flattening effect in patients with KC. • In group 1, we performed KERARING 1st followed by CXR, as effect of rings in flattenning maximum on keratoconic tissue than on rigid CXL cornea. • Also intralase for channel creation ----- higher energy to in CXL corneas which may increase haze. El-Raggal, T WCC VI, 2010

  12. Conclusion • Reason for more corneal improvement in concurrent hypothesized: 1- Newly dissected channel ------ pooling of B2 with exaggerated flattening effect of CXL. This is in contrast to healed channel. 2- Postoperative changes in epithelium anatomy & function, keratocytes apoptosis in anterior stroma at time of exaggerated haze with resultant changes in corneal remodeling. • Combined Kera rings & CXL can performed safely in 1 or 2 sessions. • However, same session is more effective regarding improvement in corneal shape. El-Raggal, T WCC VI, 2010

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