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      Keraring Intrastromal Segment Depth Measured by Spectral-Domain Optical Coherence Tomography in Eyes with Keratoconus

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          Abstract

          Purpose. To evaluate agreement between measured and intended distance of Keraring (Mediphacos, Belo Horizonte, Brazil) intracorneal ring segments from the anterior and posterior corneal surfaces. Methods. Twenty-six Keraring ICRS implanted in 24 keratoconic eyes were examined. The distance from the Keraring apex to the anterior corneal surface and the distance from the inner and the outer corners to the posterior corneal surface were measured 3 months postoperatively using spectral-domain optical coherence tomography. Agreement between measured distance and intended distance was assessed by calculating the absolute differences and 95% limits of agreement (95% LoA). Results. The mean absolute difference was significantly lower ( p < 0.001) for the measurements taken at the inner corner (23.54 ± 15.90  μm) than that for those taken at the apex (108.92 ± 62.72  μm) and the outer corner (108.35 ± 56.99  μm). The measurements taken at the inner corner were within ±25 and ±50  μm of the intended distance in 15/26 (57.7%) and 24/26 (92.3%) cases, respectively, and showed the narrowest 95% LoA with the intended distance (−57.61 to 55.15  μm). Conclusions. The distance of the inner corner from the posterior corneal surface showed the best agreement with the intended distance. This measurement is suitable for determining whether the actual Keraring depth matches the intended depth.

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          Most cited references26

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            The three-dimensional organization of collagen fibrils in the human cornea and sclera.

            The organization of collagen fibrils in the human cornea and sclera was studied by scanning electron microscopy, after digestion of cellular elements by sodium hydroxide, and by conventional transmission electron microscopy. The collagen fibrils in the cornea had a uniform diameter of about 25 nm. In Bowman's layer, individual collagen fibrils were interwoven densely to form a felt-like sheet. In the stroma, most of the collagen fibrils ran abreast in lamellae, with varying widths and thickness. These lamellae were arranged basically parallel to the corneal surface but often communicated with those of adjacent layers by interchanging their fibrils. In the innermost stromal region adjacent to Descemet's membrane, collagen fibrils were oriented in various directions and interlaced, forming loose fibrillar networks. The sclera, however, was composed of collagen fibrils with various diameters ranging from 25-230 nm. Although these collagen fibrils formed bundles, they were not parallel but were entangled in individual bundles. These collagen bundles varied in width and thickness, often gave off branches, and intertwined with each other.
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              Correcting keratoconus with intracorneal rings.

              To evaluate the potential of intrastromal corneal ring technology (Intacs, KeraVision) to correct keratoconus without central corneal scarring. Department of Ophthalmology, Brest University Hospital, Brest, France. In this prospective, noncomparative, interventional case series, Intacs segments were implanted in 10 keratoconic eyes with clear central corneas and contact lens intolerance after corneal pachymetry was checked. Segment thicknesses varied based on corneal topography analysis. No intraoperative complications occurred. The mean follow-up was 10.6 months. Postoperative results revealed a reduction in astigmatism and spherical correction and an increase in topographical regularity and increased uncorrected visual acuity. Intacs technology can reduce the corneal steepening and astigmatism associated with keratoconus.
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                Author and article information

                Journal
                J Ophthalmol
                J Ophthalmol
                JOPH
                Journal of Ophthalmology
                Hindawi Publishing Corporation
                2090-004X
                2090-0058
                2017
                2 February 2017
                : 2017
                : 4313784
                Affiliations
                1Department of Surgical Sciences, Eye Clinic, University of Turin, Turin, Italy
                2Department of Eye Diseases, Ophthalmic Hospital of Turin, Turin, Italy
                Author notes

                Academic Editor: Anna Nowinska

                Author information
                http://orcid.org/0000-0003-2852-305X
                http://orcid.org/0000-0002-9354-9005
                Article
                10.1155/2017/4313784
                5312050
                b5eb7a94-33a9-45cb-b08a-fddff5007622
                Copyright © 2017 Ugo de Sanctis et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 September 2016
                : 13 December 2016
                : 29 December 2016
                Categories
                Clinical Study

                Ophthalmology & Optometry
                Ophthalmology & Optometry

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