Table 3

Outcome of various surgical techniques in advanced corneal ectasia

AuthorSurgeryType of studyNIndicationOutcomeComplications
Rodriguez et al39Intacs SKRetrospective longitudinal case series6Post-LASIK advanced ectasiaAverage Km reduced from 53.80±6.30 D to 48.57±5.00 DNo significant complications
Khan et al40Intacs SKCase series31Moderate to severe keratoconusAverage Km reduced from 52.07 D to 46.15 D for K1 and from 57.9 D to 51.2 D for K2Segment extrusion
Sansanayudh et al41Intacs SKRetrospective non-randomised study10Advanced keratoconusSignificant improvement in visual and aberrometric outcomeNo significant complications
Fahd et al42Intacs SKCase series24Moderate to severe keratoconusReduction in myopia and astigmatism Improvement in BCVA Average Km of 52.03±4.49 DNo significant complication
Kotb and Hantera38Intacs SKProspective, non-comparative37Keratoconus, Krumeich's stage II—31 eyes, Krumeich's stage III—6 eyesSignificant improvement in UCVA at 6 monthsBullous keratopathy
Overlapping of distal end of ICRS
Varley et al43Large diameter PKPProspective non-comparative11PMDMean BCVA 20/30
Average keratometric astigmatism—2.46 D
Graft failure
Retinal detachment Bacterial corneal ulcer
Speaker et al44Large diameter PKPCase series15Keratoconus and PMD1 graft failure9/5 graft rejection
Cheng et al45Compressive C-shaped LKRetrospective, non-comparative, interventional case series4PMD/TMDNo recurrence
Stable astigmatism ranging from 0 D to −2.75 D
BCVA ≥ 20/40
Cataract progression
Shi et al46Modified deep LKProspective65Keratoconus (K> 60 D)No detectable corneal graft rejection
Average BCVA—20/25 at 1 year
 Interface fluid-9 cases
Rasheed and Rabinowitz47Simultaneous LK with PKPRetrospective, interventional case series5PMDNo graft rejection
BCVA ≥ 20/40
Increased IOP
Jones and Kirkness48LK followed by secondary PKPCase report2KeratoglobusThe right and left eye BCVA 6/60 and 6/18, respectivelyRight eye graft decompensation
Vajpayee et al49‘Tuck in’ LKRetrospective4Post-PKP corneal ectasiaMean Km decreased from 59.67 D to 43.50 D, Significant improvement of BCVA from mean of 0.05 to 0.34No significant complication
Kaushal et al50‘Tuck in’ LKProspective interventional case series12Keratoconus 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 al51Tissue excision and corneal tuckProspective interventional case series3Extremely advanced PMDStable resolution of the ectasia in all cases
BCVA—20/30 to 20/50
No significant complication
Reinhard and Sundmacher52SclerokeratoplastyCase report 2Keratoconus with peripheral ectasiaBetter contact lens fitting
Improvement in BCVA
No significant complication
Kanellopulous and Pe53CorneoscleroplastyCase report1KeratoglobusBCVA 20/50No significant complication
Maccheron and Daya54Wedge resectionRetrospective7PMDAverage reduction in keratometric cylinder of 9.1 D
Improved UCVA, BCVA, keratometric cylinder, and spectacle or CL tolerance
No significant complication
Busin et al55Combined wedge resection and bevelled penetrating relaxing incisionsProspective, non-comparative, interventional case series10PMDBCVA ≥ 20/40 in 8 of 10 cases
Keratometric astigmatism reduced from 15.1 D preoperatively to 4.6 D postoperatively
No significant complication
Cameron56Lamellar crescentic resectionProspective5PMDBCVA ≥ 20/40 in four of the five eyes.Inferior pannus, loose sutures, Recurrence
Javadi et al57Lamellar crescentic resectionProspective15PMDBCVA 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.