Two-stage treatment of ametropia in patients with keratoconus and cataracts
https://doi.org/10.29413/ABS.2021-6.6-1.23
Abstract
Keratoconus (KC) is a progressive degenerative corneal disease, leads to the aberration of biomechanical and optical properties and thinning of the cornea, causes astigmatism and decreases visual acuity.
Materials and methods. 33 patients (35 eyes) with stages II–III of non-progressive keratoconus and concomitant cataracts of various stages of maturity were operated on. The average age of the patients was 46.5 ± 2.7 (41–63) years old. The operations were performed according to our proposed two-stage method of treating ametropia in patients with KC and cataracts (Patent of the Russian Federation No. 2748634 of 28.05.2021). The first stage was the implantation of FERRARA intrastromal corneal ring segments (ICRS) with thickness from 150 to 350 μm. To correct residual refractive error in 5–7 months after stage 1, patients underwent stage 2: cloudy lens was removed and replaced with toric posterior chamber intraocular lens (TIOL) – AcrySof IQ Toric (Alcon, USA), T-fl ex Toric RayOne (Rayner, UK).
Results and discussion. After stage 1 of the operation (ICRS implantation), the uncorrected visual acuity (NCVA) was 0.2 ± 0.03, the best corrected visual acuity (BCVA) was 0.4 ± 0.02. In 1 month after stage 2 (phacoemulsifi cation + TIOL) NCVA was 0.64 ± 0.11 and BCVA was 0.74 ± 0.12. During the entire follow-up period after the surgery visual functions, refraction, and rotational stability of TIOL were stable.
Conclusions. Conducting a two-stage surgical intervention in patients with keratoconus and cataracts allows to stop the progression of the disease and effectively correct the ametropia concomitant with keratoconus.
About the Authors
M. M. Bikbov
Ufa Eye Research Institute
Russian Federation
Russian Federation
Dr. Sc. (Med.), Professor, Corresponding Member of the Academy of Sciences of the Republic of Bashkortostan, Director
Pushkina str. 90, Ufa 450008, Bashkortostan, Russian Federation
O. I. Orenburkina
Ufa Eye Research Institute
Russian Federation
Russian Federation
Cand. Sc. (Med.), Head of the Laboratory of Lens Surgery and Intraocular Correction
Pushkina str. 90, Ufa 450008, Bashkortostan, Russian Federation
A. E. Babushkin
Ufa Eye Research Institute
Russian Federation
Russian Federation
Dr. Sc. (Med.), Head of the Research Department
Pushkina str. 90, Ufa 450008, Bashkortostan, Russian Federation
I. F. Nuriev
Ufa Eye Research Institute
Russian Federation
Russian Federation
Ophthalmologist at the 2nd Microsurgical Department
Pushkina str. 90, Ufa 450008, Bashkortostan, Russian Federation
References
1. Bikbov MM, Bikbova GM, Khabibullin AF. Corneal collagen cross-linking in keratoconus management. The Russian Annals of Ophthalmology. 2011; 127(5): 21-25. (In Russ.).
2. Bikbova G, Bikbov M. Transepithelial corneal collagen crosslinking by iontophoresis of riboflavin. Acta Ophthalmol. 2014; 92(1): e30-e34. doi: 10.1111/aos.12235
3. Bikbova G, Bikbov M. Standard corneal collagen crosslinking versus transepithelialiontophoresis-assisted corneal crosslinking, 24 months follow-up: Randomized control trial. Acta Ophthalmol. 2016; 94(7): 600-606. doi: 10.1111/aos.13032
4. Bikbov M, Kazakbaeva G, Zainullin R, Gilmanshin T, Nuriev I, Zaynetdinov A, et al. Prevalence and associated factors of cataract and cataract surgery in a Russian population. The Ural Eye and Medical Study. Invest Ophthal Vis Sci. 2020; 61(7): 3857.
5. Moshirfar M, Walker BD, Birdsong O. Cataract surgery in eyes with keratoconus: A review of the current literature. Curr Opin Ophthalmol. 2018; 29(1), 75-80. doi: 10.1097/ICU.0000000000000440
6. Thebpatiphat N, Hammersmith KM, Rapuano CJ, Ayres BD, Cohen EJ. Cataract surgery in keratoconus. Eye Contact Lens. 2007; 33(5): 244-246. doi: 10.1097/ICL.0b013e318030c96d
7. Godefrooij DA, de Wit GA, Uiterwaal CS, Imhof SM, Wisse RPL. Age-specific incidence and prevalence of keratoconus: A nationwide registration study. Am J Ophthalmol. 2017; 175(5): 169-172. doi: 10.1016/j.ajo.2016.12.015
8. Bozorg S, Pineda R. Cataract and keratoconus: Minimizing complications in intraocular lens calculations. Semin Ophthalmol. 2014; 29(5-6): 376-379. doi: 10.3109/08820538.2014.959193
9. Alió JL, Peña-García P, Guliyeva F, Soria FA, Zein G, AbuMustafa SK. MICS with toric intraocular lenses in keratoconus: Outcomes and predictability analysis of postoperative refraction. Br J Ophthalmol. 2014; 98(3): 365-370. doi: 10.1136/bjophthalmol-2013-303765
10. Hashemi H, Yekta A, Khabazkhoob M. Effect of keratoconus grades on repeatability of keratometry readings: Comparison of 5 devices. J Cataract Refract Surg. 2015; 41(5): 1065-1072. doi: 10.1016/j.jcrs.2014.08.043
11. Alió JL, Pena-García P, Abdulla GF, Zein G, Abu-Mustafa SK. Comparison of iris-claw and posterior chamber collagen copolymer phakic intraocular lenses in keratoconus. J Cataract Refract Surg. 2014; 40(3): 383-394. doi: 10.1016/j.jcrs.2013.07.052
12. Kamiya K, Shimizu K, Miyake T. Changes in astigmatism and corneal higher-order aberrations after phacoemulsification with toric intraocular lens implantation for mild keratoconus with cataract. Jpn J Ophthalmol. 2016; 60(4): 302-308. doi: 10.1007/s10384-016-0449-x
13. Farideh D, Azad S, Feizollah N, Sana N, Cyrus A, Mohammad G, et al. Clinical outcomes of new toric trifocal diffractive intraocular lens in patients with cataract and stable keratoconus: Six months follow-up. Medicine (Baltimore). 2017; 96(12): е6340. doi: 10.1097/MD.0000000000006340
14. Sauder G, Jonas JB. Treatment of keratoconus by toric foldable intraocular lenses. Eur J Ophthalmol. 2003; 13(6): 577-579. doi: 10.1177/112067210301300612
15. Navas A, Suárez R. One-year follow-up of toric intraocular lens implantation in formefrustekeratoconus. J Cataract Refract Surg. 2009; 35(11): 2024-2027. doi: 10.1016/j.jcrs.2009.05.043
16. Visser N, Gast ST, Bauer NJ, Nuijts RM. Cataract surgery with toric intraocular lens implantation in keratoconus: A case report. Cornea. 2011; 30(6): 720-723. doi: 10.1097/ICO.0b013e31820009d4
17. Jaimes M, Xacur-García F, Alvarez-Melloni D, GraueHernández EO, Luquín TR, Navas A. Refractive lens exchange with toric intraocular lenses in keratoconus. J Refract Surg. 2011; 27(9): 658-664. doi: 10.3928/1081597X-20110531-01
18. Lee H, Chung JL, Kim EK, Sgrignoli B, Kim T. Univariate and bivariate polar value analysis of corneal astigmatism measurements obtained with 6 instruments. J Cataract Refract Surg. 2012; 38(9): 1608-1615. doi: 10.1016/j.jcrs.2012.04.035
19. Parikakis EA, Chatziralli IP, Peponis VG, David G, Chalkiadakis S, Mitropoulos PG. Toric intraocular lens implantation for correction of astigmatism in cataract patients with corneal ectasia. Case Rep Ophthalmol. 2013; 4(3): 219-228. doi: 10.1159/000356532
20. Shirayama M, Wang L, Koch DD, Weikert MP. Comparison of accuracy of intraocular lens calculations using automated keratometry, a Placido-based corneal topographer, and a combined Placido-based and dual Scheimpflug corneal topographer. Cornea. 2010; 29(10): 1136-1138. doi: 10.1097/ICO.0b013e3181d3d689
21. Shirayama M, Wang L, Weikert MP, Koch DD. Comparison of corneal powers obtained from 4 different devices. Am J Ophthalmol. 2009; 148(4): 528-535. doi: 10.1016/j.ajo.2009.04.028
22. Hill W, Osher R, Cooke D, Solomon K, Sandoval H, SalasCervantes R, et al. Simulation of toric intraocular lens results: Manual keratometry versus dual-zone automated keratometry from an integrated biometer. J Cataract Refract Surg. 2011; 37(12): 2181-2187. doi: 10.1016/j.jcrs.2011.06.028
23. Chang M, Kang SY, Kim HM. Which keratometer is most reliable for correcting astigmatism with toric intraocular lenses? Korean J Ophthalmol. 2012; 26(1): 10-14. doi: 10.3341/kjo.2012.26.1.10
24. Cucera A, Lang GK, Buchwald HJ. Intra- and interindividual comparison of corneal refraction measured by IOL-Master vs. corneal topography. Klin Monbl Augenheilkd. 2008; 225(11): 957-962. (In German). doi: 10.1055/s-2008-1027843
25. Online IOL calculator. URL: https://www.myalcon-toriccalc.com/ [date of access: 25.01.2019]. (In Russ.).
26. Raytrace. Premium IOL calculator. URL: https://www.raytrace.rayner.com/ [date of access: 04.10.2020].
27. Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: Relation to preoperative and intraoperative parameters. J Cataract Refract Surg. 2000; 26(5): 727-732. doi: 10.1016/s0886-3350(99)00462-9
Review
For citations:
Bikbov M.M., Orenburkina O.I., Babushkin A.E., Nuriev I.F. Two-stage treatment of ametropia in patients with keratoconus and cataracts. Acta Biomedica Scientifica. 2021;6(6-1):204-213. (In Russ.) https://doi.org/10.29413/ABS.2021-6.6-1.23
Views:
720
.png)
Email this article 
