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Keratoconus (KC) : Improvement of KC’s Visual

Rehabilitation after Intra Corneal-Rings (ICR's) with Corneo-Scleral lenses (CSL) (SPOT® LAO Laboratories)

without Cross-LinkingSolange Leroux Les Jardins, MD 1

Guillaume Leroux Les Jardins, MD 1,3,4

1 :Private Practice, Paris, France

3 : Ancien Chef de Clinique-Assistant, Université Paris V

Groupe Hospitalier Cochin - Hôtel Dieu, Paris, France

4 : Praticien Attaché Cochin-Hôtel Dieu, Paris, France

NO FINANCIAL INTERESTwww.lerouxlesjardins.comRSSD Chicago 2014

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Retrospective Study Patients with progressive and severe Keratoconus (grade 3,4) 14 eyes, 14 patients (11 men, 3 females) Pre operative spherical equivalent (SEQ): - 4.8 D (-12 to - 0.5) Pre operative astigmatism : - 4.6 D. (-7 to-1.75) BCVA LogMar : 0.39 (1 to 0.1) All Corneal Contact lenses intolerant Cross-linking not possible as all these KC eyes had too thin corneas Mean age : 32 years (18 à 60) Operated on with ICR's Femtolaser IntraLase iFis (AMO ®) used to perform intrastromal channel Using Ferrara Nomogram, Ferrara Rings (5 mm Optical Zone), 3 months at least after surgery, adapted with Corneo Scleral SPOT® lenses to get a better VA Mean Follow up 21 months (6 à 52) after ICR’s surgery

Visual Acuity (VA) exprimed in LogMar t-test (Graphpad Prism 5 Software ©), p <0.05 : significative * Résults expressed in Mean +/- Standard Error Mean (SEM) et (Min-Max)

Material & Method

STATISTIC ANALYSIS

Purpose

To study the tolerance and BCVA improvement with the use of CSL (SPOT-LAO®) (1,2)

after ICR’s surgery for KC

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CORNEO SCLERALLENSES (CS

LENSES)SPOT® (LAO) :Large diameter Corneo-scleral Contact lensesNo contact with the corneas nor

with ICR’s

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ADAPTATION WAS SUCCESSFULL FOR ALL THE PATIENTS

TOLERANCE WAS VERY GOOD FOR ALL THE PATIENTS

NONE HAD DIFFICULTIES WITH THE MANIPULATIONNO COMPLICATION

Corneo scleral Lenses don’t touch the cornea

Don’t moove on the cornea,And dust can’t go under it.

Equivalent sphérique après ICRs (n = 14Y)

Pré-op ICRs Post-op ICRs-15

-10

-5

0

5

Moyenne +/- Min-Max

* *

Différence significative p < 0,01 (p = 0,0049)

Equ

ival

ent S

phér

ique

(D

)

ICR’s RESULTS :SPHERICAL EQUIVALENT (SEQ)

( Before CS SPOTS ® LENSES) 14 EYES

PRE-OP SEQ : -4,8 D. (-0.5 à -12)POST-OP SEQ : -1.77 D. (0.5 à -5)

SIGNIFICANT DEACREASE PRE / POST-OP SEQ

P**<0,01

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AV pre ICR/post ICR/post SPOT (n=14)

Pré ICRs Post ICRs ICR + SPOT

0.0

0.5

1.0

ns ******

*** p < 0,0005

Différence significative après SPOT*** p < 0,0005

MA

VC

( L

ogM

AR

)

MEAN PRE-OP BCVA :0.39 (1.3 à 0.1) LogMAR

MEAN BCVA AFTER ICR’s0.29 (1.3 à 0.1) LogMAR : ns No significative Gain of UDVAbefore and after ICR’s(Our most difficult cases)°

MEAN BCVA AFTERICR’s ANDCSL SPOTS ADAPTATION0,07 (0. 5 à 0.1) LogMARp < 0.0005

IMPRESSIVE GAIN OFBCVA AFTER ICR’S AND SPOT CSL

BEST CORRECTED VISUAL ACUITY (BCVA) RESULTSAFTER ICR’s and AFTER ICR’s + CORNEO SCLERAL LENSES

(LogMAR)

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RESULTS

All 14 patients were equipped with CS SPOT ® All 14 patients tolerated well CS SPOT ® and learned easily the manipulationAll 14 patients had an impressive gain of BCVA None out of the 14 patients needed glasses with CS SPOT ®

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DISCUSSION

ICR’s improve visual acuity and stabilize KC (3,4,5,6)Nevertheless, Refractive result is better when KC isn’t too severe

and emmetropia is rarely obtained.In this series :

ICR’s have stabilized KC at the follow-up ICR’s have improved spherical equivallent,

But in these 14 eyes, refractive results had to be improved.It has been possible to improve refractive results with

Corneo scleral lenses with a good tolerance.No patient with ICR’s and Coreo-scleral lenses had to ware

glasses.

If we want to avoid corneal transplant to patients having severe KC, ICR’s are usefull tools to stabilize KC and to improve VA.

If necessary to perfect the refractive result, Corneo scleral lenses are also a very usefull tool and should be proposed after ICR’s if

necessary.

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CONCLUSION

In case of severe KC with too thin corneas to perform CXL, ICR’s improve KC’s CDVA and stabilizes KC

but UDVA rarely returns to emmetropia.To improve the refractive results, CS SPOT ® is a very usefull tool

and has to be known and proposed.

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BIBLIOGRAPHY

1 :Vers une réhabilitation des verres scléraux? J-M Laroche, F. Baechele, A.Delcampe, M.Drouin, M.Ortega, T. Huang-Xuan. J Fr Ophtalmol 2004 ; 27 : 877-8822 : Vision-Related Function After Scleral Lens Fitting in Ocular Complications of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Tougeron-Brousseau B, Delcampe A, Gueudry J, Vera L, Doan S, Hoang-Xuan T, Muraine M. Am J Ophthalmol. 2009 Dec ;148(6):852-93 : Correction of irregular astigmatism with intracorneal ring segments. Touboul D, Pinsard L, Mesplier N, Smadja D, Colin J. J.Fr.Ophtalmo 2012 Mars 35(3):212-94 : Outcomes of intrastromal corneal ring segments for treatment of keratoconus: Five-year follow-up analysis. Vega-Estrada A, Alio JL, Brenner LF, Burquera N. J Ctaract Refract Surg 2013, 39(8): 1234-405 : S. Leroux Les Jardins et al, ACR 2012.6 : S. Leroux Les Jardins et al, SAFIR 2013.

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