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      Complete corneal ring (MyoRing) implantation versus MyoRing implantation combined with corneal collagen crosslinking for keratoconus: 3-year follow-up

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          Abstract

          Purpose

          To estimate the effectiveness of complete corneal ring (MyoRing) implantation compared with MyoRing implantation combined with corneal collagen crosslinking (CXL) for keratoconus treatment for 36 months follow-up.

          Design

          Retrospective cohort study.

          Materials and methods

          MyoRing implantation was performed in a series of 78 patients (80 eyes) with keratoconus II–III Amsler classification, of these 39 eyes had MyoRing implantation combined with CXL. Implantation of a MyoRing in the corneal pocket was performed using a PocketMaker microkeratome and corneal intrastromal implantation system. During CXL, riboflavin solution 0.1% was injected into the corneal pocket through the incision tunnel and standard surface UVA irradiation (370 nm, 3 mW/cm 2) was then applied from 5-cm distance for 30 min.

          Results

          Significant improvements in uncorrected distance visual acuity and corrected distance visual acuity were observed for both groups, which was relatively better 12 months after procedure in MyoRing alone group; however, in 36 months there was no difference between groups. Keratometry was reduced in both groups; after MyoRing implantation for 8.45 D and MyoRing + CXL for 9.43 D, the spherical equivalent decreased from 8.45 to 7.72 D and from 9.43 to 6.25 D, respectively. The cylinder decreased to 3.33 D with MyoRing alone and to 3.31 D with MyoRing + CXL. Corneal thickness remained nearly unchanged (from 433.69 ± 38.76 to 434.21 ± 34.98) in MyoRing group and decreased from baseline (from 426.93 ± 46.58 to 401.24 ± 39.12 µm) in MyoRing + CXL group 36 months postoperatively, which corresponds with pachymetry reduction after conventional CXL.

          Conclusion

          Both MyoRing implantation and MyoRing combined with CXL were effective for treating keratoconus. At 36 months, there were slightly better outcomes in MyoRing + CXL group; however, in MyoRing alone group visual and refractive outcomes were stable overtime.

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          Most cited references27

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          Riboflavin/ultraviolet-a–induced collagen crosslinking for the treatment of keratoconus

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            Corneal collagen crosslinking with riboflavin and ultraviolet A to treat induced keratectasia after laser in situ keratomileusis.

            To determine whether riboflavin and ultraviolet-A (UVA) corneal crosslinking can be used as an alternative therapy to prevent the progression of keratectasia. Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland, and a private clinic, Athens, Greece. Corneal crosslinking was performed in 10 patients with formerly undiagnosed forme fruste keratoconus or pellucid marginal corneal degeneration who had laser in situ keratomileusis (LASIK) for myopic astigmatism and subsequently developed iatrogenic keratectasia. Surgery was performed in 1 eye per patient. Crosslinking induced by riboflavin and UVA arrested and/or partially reversed keratectasia over a postoperative follow-up of up to 25 months as demonstrated by preoperative and postoperative corneal topography and a reduction in maximum keratometric readings. Riboflavin-UVA corneal crosslinking increased the biomechanical stability of the cornea and may thus be a therapeutic means to arrest and partially reverse the progression of LASIK-induced iatrogenic keratectasia.
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              Corneal cross-linking-induced stromal demarcation line.

              Corneal collagen cross-linking by UVA/riboflavin (X-linking) represents a new method for the treatment of progressive keratoconus and currently is under clinical study. To avoid UVA irradiation damage to the corneal endothelium, the parameters for X-linking are set in a way that effective treatment occurs only in the first 300 microm of the corneal stroma. Here, X-linking not only strengthens the biomechanical properties of the cornea but also induces keratocyte apoptosis. To date, the effectiveness of treatment could be monitored only indirectly by postoperative follow-up corneal topographies or using corneal confocal microscopy. Here we describe a corneal stromal demarcation line indicating the transition zone between cross-linked anterior corneal stroma and untreated posterior corneal stroma. The demarcation line is biomicroscopically detectable in slit-lamp examination as early as 2 weeks after treatment. X-linking was performed in 16 cases of progressive keratoconus, and corneas were examined biomicroscopically and by means of corneal topography and pachymetry before and after treatment. In 14 of 16 cases, a thin stromal demarcation line was visible at a depth of approximately 300 microm over the whole cornea after X-linking treatment. This newly observed demarcation line may result from differences in the refractive index and/or reflection properties of untreated versus X-linked corneal stroma and represents an effective tool to biomicroscopically easily monitor the depth of effective X-linking treatment in keratoconus.
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                Author and article information

                Contributors
                81-43-226-2124 , Gbikbova@chiba-u.jp , Gbikbova@gmail.com
                Journal
                Int Ophthalmol
                Int Ophthalmol
                International Ophthalmology
                Springer Netherlands (Dordrecht )
                0165-5701
                1573-2630
                15 June 2017
                15 June 2017
                2018
                : 38
                : 3
                : 1285-1293
                Affiliations
                [1 ]ISNI 0000 0004 0389 9736, GRID grid.482657.a, Ufa Eye Research Institute, ; Ufa, Russia
                [2 ]ISNI 0000 0004 0370 1101, GRID grid.136304.3, Department of Ophthalmology and Visual Science, , Chiba University Graduate School of Medicine, ; Inohana 1-8-1, Chuo-ku, Chiba, Chiba 260-8670 Japan
                Author information
                http://orcid.org/0000-0002-7715-7466
                Article
                593
                10.1007/s10792-017-0593-4
                5988788
                28620706
                24340f65-4e26-4b62-8110-41d30390dfb1
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 9 January 2017
                : 5 June 2017
                Categories
                Original Paper
                Custom metadata
                © Springer Science+Business Media B.V., part of Springer Nature 2018

                Ophthalmology & Optometry
                cornea,keratoconus,corneal collagen crosslinking,myoring
                Ophthalmology & Optometry
                cornea, keratoconus, corneal collagen crosslinking, myoring

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