Outcome of various surgical techniques in advanced corneal ectasia
| Author | Surgery | Type of study | N | Indication | Outcome | Complications |
|---|---|---|---|---|---|---|
| Rodriguez et al39 | Intacs SK | Retrospective longitudinal case series | 6 | Post-LASIK advanced ectasia | Average Km reduced from 53.80±6.30 D to 48.57±5.00 D | No significant complications |
| Khan et al40 | Intacs SK | Case series | 31 | Moderate to severe keratoconus | Average Km reduced from 52.07 D to 46.15 D for K1 and from 57.9 D to 51.2 D for K2 | Segment extrusion |
| Sansanayudh et al41 | Intacs SK | Retrospective non-randomised study | 10 | Advanced keratoconus | Significant improvement in visual and aberrometric outcome | No significant complications |
| Fahd et al42 | Intacs SK | Case series | 24 | Moderate to severe keratoconus | Reduction in myopia and astigmatism Improvement in BCVA Average Km of 52.03±4.49 D | No significant complication |
| Kotb and Hantera38 | Intacs SK | Prospective, non-comparative | 37 | Keratoconus, Krumeich's stage II—31 eyes, Krumeich's stage III—6 eyes | Significant improvement in UCVA at 6 months | Bullous keratopathy Overlapping of distal end of ICRS |
| Varley et al43 | Large diameter PKP | Prospective non-comparative | 11 | PMD | Mean BCVA 20/30 Average keratometric astigmatism—2.46 D | Graft failure Retinal detachment Bacterial corneal ulcer |
| Speaker et al44 | Large diameter PKP | Case series | 15 | Keratoconus and PMD | 1 graft failure | 9/5 graft rejection |
| Cheng et al45 | Compressive C-shaped LK | Retrospective, non-comparative, interventional case series | 4 | PMD/TMD | No recurrence Stable astigmatism ranging from 0 D to −2.75 D BCVA ≥ 20/40 | Cataract progression |
| Shi et al46 | Modified deep LK | Prospective | 65 | Keratoconus (K> 60 D) | No detectable corneal graft rejection Average BCVA—20/25 at 1 year | Interface fluid-9 cases |
| Rasheed and Rabinowitz47 | Simultaneous LK with PKP | Retrospective, interventional case series | 5 | PMD | No graft rejection BCVA ≥ 20/40 | Increased IOP PSC |
| Jones and Kirkness48 | LK followed by secondary PKP | Case report | 2 | Keratoglobus | The right and left eye BCVA 6/60 and 6/18, respectively | Right eye graft decompensation |
| Vajpayee et al49 | ‘Tuck in’ LK | Retrospective | 4 | Post-PKP corneal ectasia | Mean Km decreased from 59.67 D to 43.50 D, Significant improvement of BCVA from mean of 0.05 to 0.34 | No significant complication |
| Kaushal et al50 | ‘Tuck in’ LK | Prospective interventional case series | 12 | Keratoconus with PMD (n=8) Keratoglobus (n=4) | All patients had BCVA > 20/80 Mean Km decreased from 57.54 D to 46.36 D, Mean spherical equivalent decreased from −7.8 D to 1.23 D | No significant complication |
| Busin et al51 | Tissue excision and corneal tuck | Prospective interventional case series | 3 | Extremely advanced PMD | Stable resolution of the ectasia in all cases BCVA—20/30 to 20/50 | No significant complication |
| Reinhard and Sundmacher52 | Sclerokeratoplasty | Case report | 2 | Keratoconus with peripheral ectasia | Better contact lens fitting Improvement in BCVA | No significant complication |
| Kanellopulous and Pe53 | Corneoscleroplasty | Case report | 1 | Keratoglobus | BCVA 20/50 | No significant complication |
| Maccheron and Daya54 | Wedge resection | Retrospective | 7 | PMD | Average reduction in keratometric cylinder of 9.1 D Improved UCVA, BCVA, keratometric cylinder, and spectacle or CL tolerance | No significant complication |
| Busin et al55 | Combined wedge resection and bevelled penetrating relaxing incisions | Prospective, non-comparative, interventional case series | 10 | PMD | BCVA ≥ 20/40 in 8 of 10 cases Keratometric astigmatism reduced from 15.1 D preoperatively to 4.6 D postoperatively | No significant complication |
| Cameron56 | Lamellar crescentic resection | Prospective | 5 | PMD | BCVA ≥ 20/40 in four of the five eyes. | Inferior pannus, loose sutures, Recurrence |
| Javadi et al57 | Lamellar crescentic resection | Prospective | 15 | PMD | BCVA of 20/40 in 71% of cases Mean astigmatism of 16.00 D at 6 weeks and 4.30 D 2 years postoperatively | No significant complication |
BCVA, best corrected visual acuity; CL, contact lenses; ICRS, intrastromal corneal ring segment; IOP, intraocular pressure; Km, keratometric reading; LASIK, laser in situ keratomileusis; LK, lamellar keratoplasty; PKP, penetrating keratoplasty; PMD, pellucid marginal degeneration; PSC, posterior subcapsular cataract; SK, severe keratoconus; TMD, Terrien’s marginal degeneration; UCVA, uncorrected visual acuity.