KeraRings -  New clinical pathways in keratoconus

1. KeraRings New clinical pathways in keratoconus
Dan Gore
Bruce Allan

2. At diagnosis…
Gross shape correction ICRS (CDVA <20/20, coma >3µm)
Shape stabilisation CXL
CDVA poor
CDVA good
(rigid contact lens dependent)
(spectacle dependent)
Fine shape correction PRK
Refractive correction pIOL
(≥2 years post CXL)
UDVA good
Gore DM, Shortt AJ, Allan BD Eye 2013;27:329-39
(spectacle independent)

3. KeraRing patients
• 17 eyes of 17 patients
• Femtosecond laser channels
• 16 keratoconus, 1 post-LASIK ectasia
– Age 32 (range 25-47)
– Refractive astigmatism 7.88D
– UDVA < 20/200
– CDVA 20/40
• Follow-up 20 months (range 14-25)

4. Uncorrected distance VA (n=10)
Number of eyes
2
p=0.018
1
0
Number of eyes
Pre-op
12
Corrected distance VA
Post-op
8
4
0
p<.001

5. Change in visual acuity
12
Number of eyes
10
CDVA
8
UDVA
6
4
2
0
Coma: Pre-op -4.20µm Post-op -2.75µm (p<.001)

6. Refractive astigmatism
Pre-op -7.88
Number of eyes
6
Post-op -4.18
p <.001
4
2
0
Δ spherical equivalent
6
-8
-6
-4
-2
-2
-6
-10
-14
0
Pre-op (D)
2
Post-op (D)
2
4
6
Pre -3.62D
Post -1.85D

7. Keratometry (D)
10
Δ Kmax
5
0
-5
-10
Corneal astigmatism (K2-K1)
Post-op corneal
astigmatism (D)
8
6
Kmean
Pre 49.8D
Post 48.6D
4
2
0
0
2
4
6
Pre-op corneal astigmastim (D)
8

8. Post-op
Pre-op
• Previously RGP
intolerant
• Now comfortable
in toric SCL
• PK/DALK avoided
6.00/ -2.00 x 130 -1.00/-4.25 x 60
CDVA 20/20
CDVA 20/120

9. Summary outcomes
• 4 patients progressed = CXL
• 16/18 (89%) pleased with outcome
– Central striae, CDVA 6/9, elective DALK
– CDVA 20/20 pre & post, cylinder reduced by 6D
– 5 patients in toric SCLs previously intolerant of RGPs