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    Effect of corneal allogenic intrastromal ring segment (cairs) implantation surgery in patients with keratoconus according to prior corneal cross-linking status
    (2024) Yücekul, Burcu; Tanrıverdi, Cafer; Taneri, Suphi; Keskin Perk, Fatma Feyza Nur; Karaca, Yiğit; Kılıç, Aylin
    PURPOSE: To compare the effects of corneal allogenic intrastromal ring segment (CAIRS) implantation on topographical measurements and visual outcomes of patients with keratoconus with and without corneal cross-linking (CXL) prior to the time of implantation. METHODS: Sixty-seven eyes with corneal allograft intrastromal ring segment implantation (KeraNatural; Lions VisionGift) due to advanced keratoconus were included in the study. Thirty-seven eyes had no CXL and 30 eyes had had CXL before being referred to the authors. The changes in spherical equivalent (SE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), steep keratometry (K1), flat keratometry (K2), mean keratometry (Kmean), maximum keratometry (Kmax), and thinnest pachymetry were retrospectively analyzed 6 months after the implantation. RESULTS: The median age was 29 years in the CXL group and 24.0 years in the non-CXL group (P > .05), respectively. All topographical and visual parameters before implantation were similar in both groups (P > .05 for all parameters). At 6 months, CDVA, K1, and Kmean showed higher improvement in the non-CXL group than the CXL group (P = .030, .018, and .039, respectively). CONCLUSIONS: CAIRS surgery has a flattening effect on both the corneas with and without CXL. The cornea with prior CXL treatment had less flattening effect due to the stiffening effect of prior CXL.
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    Efficacy and safety of intracorneal allogenic ring segment implantation in keratoconus: 1-year results
    (Springer Nature, 2023) Aşık Nacaroğlu, Şenay; Yeşilkaya, Elif Ceren; Keskin Perk, Fatma Feyza Nur; Tanrıverdi, Cafer; Taneri, Suphi; Kılıç, Aylin
    BackgroundTo evaluate the safety and efficacy of corneal allogenic intrastromal ring segments in the management of keratoconus patients.MethodsThe retrospective, nonrandomized, interventional case series consisted of 65 keratoconic eyes of 49 consecutive patients who had ring segment-shaped corneal allografts (KeraNatural (R)) implanted in intrastromal tunnels created using a femtosecond laser. The main outcome measures were uncorrected visual acuity (UCVA), corrected distant visual acuity (CDVA), refraction, keratometry, and pachymetry. Computed tomography scans of the corneal surfaces were also performed preoperatively as well as 3, 6 and 12 months postoperatively.ResultsMean age was 29.5 +/- 7.3 years (median 29, range: 20-52 years). The mean UCVA improved from 0.91 +/- 0.50 logMAR preoperatively to 0.40 +/- 0.24 logMAR postoperatively at 6 month follow-up (p < 0.01) and the mean CDVA improved from 0.87 +/- 0.20 logMAR preoperatively to 0.27 +/- 0.06 logMAR postoperatively (p < 0.01). The mean spherical equivalent improved from -8.82 +/- 4.57 to -3.45 +/- 4.81D (p < 0.01). Average Keratometry decreased from 49.23 +/- 5.22 preoperatively to 45.63 +/- 4.89 D postoperatively (p < 0.01). Mean anterior and posterior maximum elevation were also decreased significantly (p < 0.01). In one patient, dislocation of the graft towards the tunnel incision site and dehiscense at the tunnel entrance were observed in the first week of the operation. Yellow-white deposits were observed in the segment tunnels in five cases after 6 months.ConclusionThis study demonstrated that implantation of corneal allograft ring segments is a viable alternative treatment for keratoconus with safety and good visual results.
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    Increasing depth of focus with allogeneic presbyopic inlays: 3-year results
    (NLM (Medline), 2023) Keskin Perk, Fatma Feyza Nur; Taneri, Suphi; Tanrıverdi, Cafer; Hacıağaoğlu, Sezer; Karaca, Zeki Yiğit; Kılıç, Aylin
    PURPOSE: To demonstrate the safety and efficacy of allogenic corneal inlays designed to increase the depth of focus (DoF) in treated eyes. SETTINGS: Medipol University Hospital, Istanbul, Turkey. DESIGN: Prospective case series. METHODS: This study includes 50 eyes of 25 patients with a follow-up of 3 years. Emmetropic patients with presbyopia had implantation of allogenic corneal inlays in the nondominant eye. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and uncorrected near visual acuity (UNVA) were evaluated in all eyes. A subjective visual acuity test system (Multifocal Lens Analyzer 3.0 application) was used to analyze the DoF by measuring the defocus curves. RESULTS: No significant difference between the treated and fellow eyes in UDVA and CDVA was found, whereas UNVA was significantly better in the treated eyes ( P = .20, P = .07, P < .01, respectively). Comparing to the preoperative CDVA, there was a 1-line decrease in CDVA in 6 (%24) patients. The mean defocus curves reveal a DoF of 1.1 diopters (D) for the untreated eye at the logMAR = 0.2 threshold. By contrast, the mean DoF of the treated eye and binocularly was 2.8 D. The areas under the curve were significantly better in the near, intermediate, and total distances in the treated eyes, whereas it was better for the far distances in the untreated eyes. All values were significant ( P = .023 total, P < .01 others). CONCLUSIONS: Allogenic presbyopic inlay implantation may be safe and provided a clinically and statistically significant increase in the DoF leading to good far, intermediate, and near-visual acuity in emmetropic presbyopic patients.