This presentation has been exposed at ESCRS 2015 Barcelona.

1. FULL RING INTRACORNEAL
IMPLANTATION IN PMD
Sahar Mojaled Nobari( PhdC), Consuelo Villena(PhD), Khosrow Jadidi (PhD)

2. INTRODUCTION
MyoRing is a full ring intracorneal implant that inserts
into the cornea using the Pocketmaker Microkeratome
or femtosecond laser. The use of MyoRing
implantation has proven to be safe and effective
procedure in patients with high myopia, post lasik
ectasia and keratoconus.

3. INTRODUCTION
This study evaluates the visual and refractive outcomes
as well as the patient´s satisfaction and ocular
symptoms after MyoRing implantation in patients with
Pellucid Marginal Degeneration (PMD). To our
knowledge this is the first study on MyoRing
implantation in patients with PMD

4. PATIENTS & METHODS
 Retrospective study : 15 eyes of 15 patients,(11males &4 females) ranging in age from 22 to
49 years old
 Surgical technique : MyoRing implantation using PocketMakerMicrokeratome
 Follow-up : 10 months (range 6-12 months)
 Inclusion criteria : poor visual acuity with spectacle,contact lens intolerance or dissatisfaction,
clear central cornea, minimum corneal thickness 360 microns and mean keratometry between
45 to 52 diopter
 Exclusioncriteria: otheroculardisease, pregnancy, diabetes , previous ocularsurgery
 Diagnosis : slit lamp examination ( inferior corneal thining, ectasia above the area the
maximum thining ), Corneal topography( butterfly or kissing birds pattern) and refractive
finding (against–the-rule astigmatism with CDVA loss)
 Patients were asked about their visual symptoms and general satisfaction , based on 6-point

5. Visual and Refractive Outcomes
Parameter Preoperative postoperative p-value
UCVA (log MAR)
Mean ± SD 1.13 ± 0.21 0.24 ± 0.12 <0.001
Range 0.7 to 1.30 0 to 0.50
BCVA (log MAR)
Mean ± SD 0.40 ± 0.12 0.18 ± 0.09 <0.001
Range 0.3 to 0.7 0 to 0.4
Sphere(D)
Mean ± SD -3.20 ± 3.4 0.01 ± 1.9 <0.001
Range -10 to 0 -5.00 to 2.50
Cylinder(D)
Mean ± SD -5.50 ± 1.2 -1.70 ± 1.00 <0.001
Range -7.00 to -3.00 -3.50 to 0
Spherical Equivalent(D)
Mean ± SD -6.00 ± 3.6 -0.70 ± 1.9 <0.001
Range -13.00 to -1.75 -6.00 to +1.75

6. Mean of the Keratometric (K) Values Preoperatively and Postoperatively as
Well as the Amount of Reduction.
K- Readings Preoperative Postoperative Pre-Postǂ
P-value
Kmax (D) 51.1 ± 2.4 46.1 ± 2.00 5.00 D <0.001
Kmin (D) 44.8 ± 2.00 43.7 ± 2.1 1.10 D <0.001
Kaverage (D) 48.0 ± 2.2 44.0 ± 2.6 4.00 D <0.001
A significant reduction wasobserved in maximum, minimum and average
keratometry after MyoRing implantation.

7. Visual Symptoms and Patient´s Satisfaction Score Postoperatively (based
on 6-point likert scale)
parameters No Very low Low Moderate High Very high
Halo (%) 5 (33.3) 5 (33.3) 2 (13.3) 2 (13.3) 1 (6.7) 0
Glare (%) 5 (33.3) 3 (20) 5 (33.3) 1 (6.7) 1 (6.7) 0
Night Vision (%) 6 (40) 2 (33.3) 3 (20) 4 (26.7) 0 0
Fluctuation (%) 9 (60) 4 (26.7) 2 (6.7) 0 0 0
Activity Limitation (%) 12 (80) 2 (13.3) 1 (6.7) 0 0 0
Overall Satisfaction (%) 0 0 1(6.7) 2(13.3) 5 (33.3) 7 (46.7)

8. CONCLUSION
 MyoRing implantation by means of PocketMaker Microkeratome
appears to be a safe and effective method fortreating pellucid marginal
degeneration.
 Both UCVA and BSCVA improved significantly. The improvement in
UCVA was remarkable ( 9 lines of snellen acuity)
 The considerable corneal flattening is due to the circular shape of
MyoRing which leads to a more significant arc-shortening effect on the
cornea
 All patients were satisfied with MyoRing implantation
 Further randomized, prospective studies with longer follow-up period is
recommended to evaluate the stability of MyoRing implantation and its