Dr. Jadidi presentation at the 2014 Total Keratoconus Solution user meeting organized by Mediphacos London, 2014 ESCRS

1. “355° experience”

2.  KC; Bilateral, Progressive, Non-inflammatory disease
 Exact etiology is unknown
 ICRS shown to be very effective
 Keraring 355º, a new option for ring selection
 Specifically designed for nipple type KC

3. BEHRC
Keratoconic &PMD
Patients
Baseline ophthalmology exam
Keraring 355º implantation
Analysis
•>20 years old
• Confirm diagnosis
• Min CT 360 μ
• Mean k 45 to 52 D
• UCVA ≤ 20/50
•Without h/o severe
ocular & systemic
pathologies
• hyperopia
To determine
efficacy and
safety of
Keraring 355º
implantation
for a 6 months
duration
1 day, 1,3 &6 months

4.  The Bina Eye Hospital Research Center Study data set
contains information on 105 subjects with Keraring 355º
implantation
 Patients with keratoconic eyes and pellucid marginal
degeneration cases that completed at least 6 months follow-up
were extracted

5. Keraring 355º ICR Dimension
spherical equivalent Diameter (mm) Thickness(μm)
< 6 D 5.7mm 200μm
> 6 D. 5.7mm 300μm

6. Keraring 355º ICR Dimension
Myopia Diameter (mm) Thickness(μm)
< -3 D 5.7mm 200μm
> -3D 5.7mm 300μm

9. DEMOGRAPHIC DATA for KERATOCONUS PATIENTS
Number of Eyes 15
OD (%) 7 (46.7%)
OS (%) 8 (53.3%)
Sex
Male (%) 12 (80%)
Female (%) 3 (20%)
Age
Mean (SD) 27.87 (6.94)
Range 21-49

10. Preoperative 1 Months
Postoperatio
n
3 Months
Postoperatio
n
6 Months
Postoperatio
n
p-value
3 vs. pre p-value
6 vs. pre
p-value
6 vs. 3
UCVA
(LogMAR)
Mean (SD)
0.79 (0.48) 0.50 (0.26) 0.44 (0.25) 0.28 (0.15) 0.005** 0.001** 0.002**
BSCVA
(LogMAR)
Mean (SD) 0.36 (0.21) 0.34 (0.19) 0.29 (0.17) 0.18 (0.09) 0.19 0.009** 0.007**
Sphere (D)
Mean (SD) -2.38 (1.85) -0.33 (2.34) -0.62 (2.79) -0.25 (2.27) 0.052 0.019* 0.242
Cylinder (D)
Mean (SD) -4.27 (1.25) -2.18 (0.82) -1.78 (1.22) -1.88 (0.95) <0.001** <0.001** 0.714
SE (D)
Mean (SD) -5.46 (1.52) -2.35 (1.67) -2.09 (2.19) -2.01 (1.63) <0.001** <0.001** 0.822

13. Preoperative 6 Months
Postoperation
p-value
K.Max Value (D)
Mean (SD)
50.39 (2.14) 44.22 (2.17)
<0.001**
K.Min Value(D)
Mean (SD)
45.85 (1.94) 42.14 (2.53)
<0.001**
K.Mean Value (D)
Mean (SD)
48.11 (1.95) 43.31 (2.31)
<0.001**

14. A B

15. Satisfaction Score
(N=15)
Frequency (%) Mean (SD)
No 0.0 (0.0%)
4.27 (1.16)
Very little 2.0 (13.3%)
Little 0.0 (0.0%)
Moderate 7.0 (46.7%)
Much 4.0 (26.7%)
Very much 2.0 (13.3%)

17. Characteristic Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6
Demographics
Sex Male Male Male Male Male female
Age,yr 21 36 29 30 40 33
Eye Os OD OS Os Os Os
Diagnosis PMD PMD PMD PMD PMD PMD

18. Characteristic Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6
UCVA
Pre op. 0.05 0.1 0.05 0.3
1 M post op. 0.6 0.4 0.5 0.2
3 M post op. 0.7 0.7 0.6 0.4
6 M post op. 0.9 0.6 0.5 0.5
BCVA
Pre op. 0.5 0.3 0.6 0.6
1 M post op. 0.6 0.5 0.7 0.4
3 M post op. 0.7 0.8 0.7 0.7
6 M post op. 0.9 0.7 0.9 0.7
Sphere (D)
Pre op. -3.25 -2 -2 -2 -1
1 M post op. 0 0.5 1 -2 2
3 M post op. 1.5 1 2 1.5 1.5
6 M post op. 1.5 1.5 2 2 1.5

19. Cylinder (D)
Pre op. -2 -6 -3.25 -6 -4
1 M post op. -3 -1.5 -3 -3 -3.5
3 M post op. -2 -1 -2 -3 -3.5
6 M post op. -1 -1 -3 -3 -3
K.Max (D)
Pre op. 50.8 51 49.9 46.5 50.6
1 M post op. 39.8 39.2 40 37.8 41.6
3 M post op. 42.2 38.5 42.9 40.2 43.4
6 M post op. 44 37.3 43.3 40.6 43
K.Min(D)
Pre op. 47.7 45.1 46.7 38.7 44.7
1 M post op. 36 36.2 37.6 36.1 38.3
3 M post op. 38.9 37.2 39.7 36.6 40.1
6 M post op. 39.4 35.7 39.8 37.1 39.1
K.Mean (D)
Pre op. 49.1 48.5 48.3 46 47.6
1 M post op. 37.9 37.7 38.8 36.9 39.9
3 M post op. 40.5 37.8 41.3 38.4 41.7
6 mo postoperative 41.7 41.5 36.7 41.5 38.8 41

20. Satisfaction Score (N=6) Frequency (%) Median (25th,75th)
No 0.0 (0.0%)
3.5 (1.25,5.00)
Very little 2.0 (25.0%)
Little 1.0 (12.5%)
Moderate 1.0 (12.5%)
Much 1.0 (12.5%)
Very much 3.0(37.0%)

21. Pre-OP UCVA: 1/10
-2 -6 *124 BCVA: 4/10
Post-OP UCVA: 7/10
-0.5 *110 BCVA: 10/10

29.  ICRS (KeraRing 355°) implantation appears to be an efficient
and minimally invasive procedure in keratoconic & PMD
patients .
 Further follow-up and additional cases are needed to draw
final conclusions

30.  Pocket better than tunnel
 Location of incision adjust to steep meridian
 Surgury must be performed in the operating room
especially with surgical microscope
 Centralization of ring should be done with
keratoscope(not pupil centre)
 Last but not least for beter astigmatism
correction make use of arcuate incision

31.  Comparison between Myoring and Keraring 355° Implantation for treatment of
Keratoconus: A Randomised, Double-blind, Two Parallel-groups clinical trial
 Clinical Outcomes After Keraring 355° Implantation in post-LASIK Corneal
Ectasia Using the pocket maker microkeratom Technology: one year follow-up
 Comparison of manual and pocket maker surgical techniques
 Clinical Outcomes After Keraring 355° Implantation in pellucid marginal
degeneration Using the pocket maker microkeratom Technology: one year follow-up
 Modelling of intraocular lens power calculation after implantation of ICRS
 Aberrometric Outcomes of Intrastromal Corneal Ring(KeraRing 355) in
Patients with Keratoconus

32. THANK YOU