This study assessed the predictability, stability and safety of MyoRing implantation in keratoconic eyes during a one year follow up period. The MyoRing implantation led to an impressive reduction in spherical and cylinder components of refraction by flattening the central cornea. Both uncorrected and corrected visual acuity significantly improved at 12 months, while refractive and visual outcomes remained stable between 3 to 12 months. The procedure was found to be safe and effective for managing moderate to severe keratoconus.

1. Predictability, stability and safety of MyoRing
implantation in keratoconic eyes during one year
follow-up
SaharMojaled Nobari(PhDc), Consuelo Villena(PhD), Khosrow Jadidi(MD)

2. INTRODUCTION
MyoRing is a full-ring intracorneal implant (DIOPTEX GmbH)
that inserts into the cornea by means of PocketMaker
Microkeratome or femtosecond laser. The mechanism of action
for MyoRing implantation is volume added in the periphery which
leads to a new biomechanical equilibrium of the cornea, thereby
flattening its center.The MyoRing implantation has been used to
manage high myopia, keratoconus and post LASIK ectasia.

3. PURPOSE
 To assess the stability of visual
and refractive outcomes that
was compared between 3 and
12 months after MyoRing
implantation in moderate and
severe keratoconus.

4. PATIENTS AND METHODS
 Retrospective cohort study: 54 eyes of 50 patients (27 males and 23 females)
with stage II and III keratoconus according to Amsler classification.
 Surgical technique: MyoRing (Dioptex GmbH) implantation by means of
PocketMaker Microkeratome.
 MyoRing dimensions : MyoRing nomogram (Daxer): corneal thickness at its
thinnest point and the mean central keratometry (K) – reading.
 Inclusion criteria: +19 years, contact lens intolerance, clear central corneas,
proof of keratoconus evolution and minimal corneal thickness >350 m.μ
 Exclusion criteria: stage I and IV keratoconus, hydrops, corneal opacity,
corneal dystrophy, herpetic keratitis, previous ocular surgery (including CXL),
pregnancy, autoimmune or other systemic disease.

5. RESULTS
 The mean age was 28.48± 6.3 years old [range 20 to 45].
 Patients were followed at 1, 3, 6, and 12 months postoperatively..
 The results of this study showed an overall 10 and 4 lines (logMAR) improvement
in the mean UDVA and CDVA at 12 months postoperatively., respectively.
 Both the spherical equivalent (SE) and the maximum keratometry value
decreased significantly by 6.00 D (p<0.001).
 There was no significant difference in visual and refractive outcomes between 3
and 12 months postoperatively.
 There was no complication in any case during the surgery or follow-up.
 In terms of refractive predictability, 47 eyes (87%) were within ± 1.00 D and 31
eyes (57.4%) were within ±0.50 D of emmetropia.

6. RESULTS

7. RESULTS

8. CONCLUSION
 MyoRing implantation leads to an impressive reduction of
spherical and cylinder components of manifest refraction by
flattening the central cornea.
 MyoRing implantation was a safe and effective procedure for the
management of moderate and severe keratoconus.
 MyoRing implantation significantly improved both UDVA and
CDVA, although the improvement of UDVA was more impressive
(approximately 10 lines of log MAR).

9. CONCLUSION
 The remarkable improvement in UDVA and spherical component of
refraction is probably due to the specific circular shape of MyoRIng which
impacts strongly on corneal power and spherical component of refraction.
 The stability of visual and refractive outcomes between 3 and 12 months
postoperatively indicates that MyoRing could affect keratoconus
progression.
 Further prospective, randomize studies are recommended to establish the
role of MyoRing in controlling the progression of keratoconus.

10. CONCLUSION
 The remarkable improvement in UDVA and spherical component of
refraction is probably due to the specific circular shape of MyoRIng which
impacts strongly on corneal power and spherical component of refraction.
 The stability of visual and refractive outcomes between 3 and 12 months
postoperatively indicates that MyoRing could affect keratoconus
progression.
 Further prospective, randomize studies are recommended to establish the
role of MyoRing in controlling the progression of keratoconus.