Improving Refractive Outcomes in Keratoconic Eyes

Two recent meta-analyses help inform management strategies.

Abdulkader Almosa, BS, BGS, and Zaina Al-Mohtaseb, MD

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Recent research assessed how to improve refractive outcomes in eyes with keratoconus A meta-analysis of 14 clinical studies found that the implantation of corneal allogeneic intrastromal ring segments significantly improved the distance visual acuity of patients with keratoconus A meta-analysis of 16 observational studies found that posterior chamber ICLs (both the Visian and EVO models, STAAR Surgical) significantly improved the vision of patients with keratoconus Visual and Topographic Outcomes After Corneal Allogeneic Intrastromal Ring Segments for Keratoconus: A Systematic Review and Meta-Analysis Friedrich M, Auffarth GU, Soiberman U, Augustin VA, Khoramnia R, Son HS1Industry support for this study: None ABSTRACT SUMMARY This systematic review and meta-analysis evaluated visual, refractive, and topographic outcomes after the implantation of corneal allogeneic intrastromal ring segments (CAIRS) in keratoconic eyes. The investigators screened major medical literature databases and included 14 peer-reviewed clinical studies comprising 442 eyes total. The primary outcome was the change in patients’ corrected distance visual acuity (CDVA), with secondary outcomes including their uncorrected distance visual acuity (UDVA), spherical equivalent (SE), refractive cylinder, keratometry parameters, higher-order aberrations (HOAs), and postoperative complications. STUDY IN BRIEF A systematic review and meta-analysis of 14 clinical studies (442 eyes) found that the implantation of corneal allogeneic intrastromal ring segments (CAIRS) significantly improved the uncorrected and corrected distance visual acuity of patients with keratoconus and reduced their keratometric values with a low rate of complications. WHY IT MATTERS CAIRS are a minimally invasive, tissue-based alternative to synthetic intrastromal corneal ring segments and keratoplasty in select keratoconus patients. The improvements in visual, refractive, and topographic outcomes combined with a favorable safety profile demonstrated in this study suggest that CAIRS could offer a way to improve the vision of patients with keratoconus while also reducing their dependence on contact lenses. Pooled analysis demonstrated a mean improvement in patients’ CDVA and UDVA of 0.37 logMAR and 0.43 logMAR, respectively—approximately 4 Snellen lines. The SE improved by 4.59 D, and maximum keratometry was reduced by 4.49 D. Reductions were also observed in mean keratometry values and total HOAs, and the thinnest pachymetry reading remained relatively stable. One reported severe adverse event (0.2%) involved acute graft rejection and required CAIRS explantation.

Go-to Techniques for Complex Cataract Cases

Three surgeons share the maneuvers they rely on to improve control, safety, and efficiency in eyes with soft or dense nuclei, during IOL exchange, and in eyes with intumescent white cataracts.

Rosa Braga-Mele, MD, MEd, FRCSC; Uday Devgan, MD, FACS; and H. Burkhard Dick, MD, PhD, FEBOS-CR

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Pocket chop creates a central groove that improves visualization and lets surgeons control soft or dense nuclei without advancing a chopper blindly toward the equator The twist-and-out technique removes a foldable IOL through the original phaco incision by rolling the optic, avoiding intraocular cutting and incision enlargement For intumescent white cataracts, a two-OVD strategy indents the anterior capsule, lowers the pressure gradient, and supports controlled capsulorhexis formation Pocket Chop for Soft and Dense Cataracts Rosa Braga-Mele, MD, MEd, FRCSC Many new tools and phaco technologies have made cataract surgery easier to manage, particularly in challenging situations. One technique that works reliably well with newer technologies is pocket chop, which can improve efficiency and safety in eyes with a soft or dense cataract.1 The beginning of a central groove, or pocket, is created in the center of the lens. The phaco needle is then embedded in the pocket with no vacuum for soft nuclei or with high vacuum for dense nuclei (Figure 1). A chopper is advanced from the distal edge of the capsulorhexis toward the pocket to create a horizontal chop (Figure 2).

Implant Refill in the Office

Kourous A. Rezaei, MD; Nicole Eter, MD; John Kitchens, MD; and Anat Loewenstein, MD

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