Corneal densitometry in patients with keratoconus undergoing intrastromal Ferrara ring implantation.

OBJECTIVE: Evaluation of central corneal densitometry changes following Ferrara corneal ring segment implantation in patients with keratoconus, especially the correlation between corneal densitometry and keratometry. METHODS: Retrospective, non-comparative, interventional study based on the review of medical records of patients diagnosed with keratoconus who underwent Ferrara corneal ring segment implantation. Pre and post-operative corneal densitometry measurements obtained with Pentacam HR (Oculus, Wetzlar, Germany) were analyzed. The follow-up time was 3 months, and data comparison was made, using specific statistical analysis, with the data of 3 months postoperatively. RESULTS: The study sample consisted of 43 eyes of 36 patients. The mean corrected visual acuity improved from 0.82 LogMAR preoperatively (SD ± 0.33) to 0.19 LogMAR (SD ± 0.13) postoperatively. The mean spherical equivalent varied from -4.63 (SD ± 3.94) preoperatively to -2.16 (SD ± 2.63) postoperatively. Asphericity varied from -0.69 (SD ± 0.32) preoperatively to -0.27 (SD ± 0.31) postoperatively. The mean maximum K was 54.01D (SD ± 3.38) preoperatively and 51.50D (SD ± 2.90) postoperatively. The mean anterior densitometric value was 18.26 (SD ± 2.03) preoperatively and 17.66 (SD ± 1.84) postoperatively. CONCLUSION: Corneal densitometry is an interesting technology that should be studied in keratoconus patients. Our results suggest that the corneal densitometry in the cornea's anterior layer reduces after ICRS implantation and correlates with corneal keratometry. Further studies should be performed to increase the knowledge in this field.

Clinical Outcomes After Implantation of 320°-Arc Length Intrastromal Corneal Ring Segments in Keratoconus.

PURPOSE: To evaluate the clinical outcomes after implantation of a new 320°-arc length Ferrara intrastromal corneal ring segment (320-ICRS) in eyes of patients with keratoconus. METHODS: A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure. RESULTS: The mean follow-up time was 6.2 ± 3.3 (SD) months (range 3-12 months). Mean UDVA improved from 20/250 to 20/60. Mean CDVA improved from 20/100 to 20/40. Mean Q improved from -1.12 ± 0.49 preoperatively to -0.28 ± 0.51 postoperatively (P < 0.001). Mean corneal volume increased from 56.2 ± 4.28 mm preoperatively to 57.6 ± 4.74 postoperatively (P < 0.001). Mean Km reduced from 53.3 ± 5.5 D preoperatively to 47.8 ± 4.6 D postoperatively (P < 0.001). The change in UDVA, CDVA, and topographic astigmatism was statistically significant (P < 0.0001). CONCLUSIONS: The 320-ICRS can efficiently and safely improve visual acuity in keratoconus, modifying the corneal shape to a more physiologic, aspheric shape.

Clinical outcomes after implantation of a new intrastromal corneal ring with 140-degree of arc in patients with corneal ectasia.

AIM: To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment (ICRS) with 140-degrees of arc in eyes with corneal ectasia. METHODS: We evaluated patients with corneal ectasia implanted with Ferrara 140° ICRS from April 2010 to February 2015. Outcome measures included preoperative and postoperative corrected distance visual acuity (CDVA), keratometry simulated (K) reading, tomographic astigmatism and asphericity. All patients were evaluated using the Pentacam Scheimpflug system. RESULTS: The study evaluated 58 eyes. The mean follow-up was 16.81±10.8mo. The CDVA (logMAR) improved from 0.5±0.20 (20/60) to 0.3±0.21 (20/40) (P<0.01). The average K reduced from 49.87±7.01 to 47.34±4.90 D (P<0.01). The asphericity changed from -0.60±0.86 to -0.23±0.67 D (P<0.01). The mean preoperative tomographic astigmatism decreased from -8.0±3.45 to -4.53±2.52 D (P<0.01). CONCLUSION: The new ICRS model with 140-degrees of arc effectively improve the visual acuity and reduce the high astigmatism usually found in patients with corneal ectasia.

Heparanase Overexpresses in Keratoconic Cornea and Tears Depending on the Pathologic Grade.

BACKGROUND: Keratoconus has classically been defined as a noninflammatory disorder, although recent studies show elevated levels of inflammatory markers suggesting that keratoconus could be, at least in part, an inflammatory condition. Heparanase upregulation has been described in multiple inflammatory disorders. In this article, we study the differential expression of heparanase in cornea and tears from keratoconus patients and healthy controls. METHODS: A transcriptomic approach was used employing quantitative polymerase chain reaction to analyze the expression of heparanase and heparanase 2 in stromal and epithelial corneal cells. The protein expression was analyzed by immunohistochemistry in corneal sections. Enzymatic activity in tears was measured using [3H]-labeled heparan sulfate as substrate. RESULTS: Heparanase transcription was detected in stromal and epithelial cells and appeared upregulated in keratoconus. Overexpression of the enzyme was also detected by immunohistochemistry. Corneal expression of heparanase 2 was detected in some cases. Heparanase catalytic activity was found in tears and displayed a positive correlation with the degree of keratoconus. CONCLUSIONS: Heparanase overexpresses in keratoconic corneas, possibly reinforcing the inflammatory condition of the pathology. The presence of heparanase activity in tears allows us to propose its use as a biomarker for the diagnosis of the disorder.

Evaluation of anterior and posterior surfaces of the cornea using a dual Scheimpflug analyzer in keratoconus patients implanted with intrastromal corneal ring segments.

AIM: To evaluate corneal parameters measured with a dual Scheimpflug analyzer in keratoconus patients implanted with intrastromal corneal ring segments (ICRS). METHODS: Fifty eyes of 40 keratoconus patients had Ferrara ICRS implantation from November 2010 to April 2014. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), refraction, keratometry, asphericity, elevation, pachymetry, root mean square (RMS), spherical aberration and coma were studied. All patients were evaluated using a dual Scheimpflug system. RESULTS: The mean follow-up time after the procedure was 12.7mo. The mean UCVA improved from 0.82 to 0.31 (P<0.001); the mean BCVA improved from 0.42 to 0.05 (P<0.0001), the mean spherical refraction changed from -3.06±3.80 D to -0.80±2.5 D (P<0.0001) and the mean refraction astigmatism reduced from -4.51±2.08 D to -2.26±1.18 D (P<0.0001). The changes from preoperative to postoperative, in parameters of the anterior and posterior surface of the cornea, were statistically significant except the elevation posterior at the apex of the cornea and posterior asphericity. CONCLUSION: The implantation of Ferrara ICRS induces changes in both anterior and posterior surfaces of the cornea.

Intrastromal corneal ring segments implantation in patients with keratoconus: 10-year follow-up.

PURPOSE: To evaluate the long-term safety and efficacy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with keratoconus. METHODS: The chart records of 36 eyes of 30 patients with keratoconus implanted with ICRS, operated on between July 1996 and January 2002, were retrospectively reviewed. The following parameters were studied: uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry (K), and central corneal thickness. The outcomes were evaluated at 5 and 10 years after ICRS implantation. RESULTS: The mean UDVA (logMAR) improved from 1.01 ± 0.28 (20/200 Snellen) to 0.71 ± 0.38 (20/100 Snellen) at 5 years (P < .05) and 0.67 ± 0.25 (20/90 Snellen) at 10 years (P = .735). The mean CDVA (logMAR) improved from 0.45 ± 0.45 (20/55 Snellen) to 0.24 ± 0.19 (20/35 Snellen) at 5 years (P < .05) and 0.29 ± 0.09 (20/38 Snellen) at 10 years (P = .292). The mean maximum K value decreased from 54.99 ± 6.33 to 50.58 ± 5.11 D at 5 years (P < .05) and 50.65 ± 5.17 D at 10 years (P = .854). The mean minimum K value decreased from 48.85 ± 5.70 to 46.90 ± 5.08 D at 5 years (P < .05) and 47.12 ± 4.22 D at 10 years (P = .945). The central corneal thickness decreased from 457.42 ± 58.21 to 421.34 ± 74.12 µm at 5 years (P = .039) and 434.32 ± 77.65 µm at 10 years (P = .427). CONCLUSIONS: Intrastromal corneal ring segments can effectively improve UDVA and CDVA 10 years after implantation in patients with keratoconus.

Clinical outcomes after intrastromal corneal ring segments reoperation in keratoconus patients.

AIM: To evaluate the clinical outcomes after Ferrara intrastromal corneal ring segments (ICRS) reoperation in patients with keratoconus. METHODS: A total of 37 keratoconus eyes implanted with intrastromal corneal ring segments, which had an ICRS exchange, addition, reposition or removal were evaluated. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry (K), asphericity (Q) and pachymetry at the thinnest point (PTP) of the cornea were evaluated using a corneal tomography (Oculus Pentacam, USA). RESULTS: The mean follow-up time after the reoperation was 30.5±9.7 months. The mean UCVA improved from 20/300 to 20/80 (P=0.005); the mean BCVA improved from 20/160 to 20/50 (P=0.0002), the mean keratometry reduced from 49.33±4.19D to 46.16±3.90D (P=0.0001), the mean pachymetry at the thinnest point increased from 450±42.9µm to 469±40.8µm (P=0.0001). The asphericity increased from -0.84±0.74 to -0.35±0.81 (P=0.15) and the spherical equivalent reduced from -4.64±4.87D to -3.04±3.45D (P=0.137). The changes in the asphericity and spherical equivalent were not statistically significant. CONCLUSION: Ferrara ICRS implantation showed to be a reversible and readjustable surgical procedure for keratoconus treatment. Good outcomes can be obtained even after removal, addition, reposition or exchange of ICRS.

Intrastromal corneal ring segment implantation to correct astigmatism after penetrating keratoplasty.

PURPOSE: To evaluate the clinical outcomes of implantation of Ferrara intrastromal corneal ring segments (ICRS) in patients with astigmatism after penetrating keratoplasty (PKP). SETTING: Private clinic, Belo Horizonte, Brazil. DESIGN: Retrospective consecutive case series. METHODS: Chart records of post-PKP patients who had ICRS implantation from May 2005 to September 2009 were retrospectively reviewed. The following parameters were studied: corrected distance visual acuity (CDVA), keratometry (K) values, spherical equivalent (SE), spherical refractive error, corneal topographic astigmatism, minimum K, and maximum K. RESULTS: The study evaluated 59 eyes (54 patients). The mean CDVA (logMAR) improved from 0.45 ± 0.17 (SD) (range 0.18 to 1.00) to 0.30 ± 0.17 (range 0.00 to 1.00). The mean SE was -6.34 ± 3.40 diopters (D) (range 0.37 to -16.50 D) preoperatively and -2.66 ± 2.52 D (range 0.87 to -10.50 D) postoperatively. The mean spherical refractive error decreased from -7.10 ± 3.07 D (range 2.15 to 16.68 D) preoperatively to -3.46 ± 2.05 D (range 0.88 to 10.79 D) postoperatively. No patient lost visual acuity. The mean corneal topographic astigmatism decreased from 3.37 ± 1.51 D preoperatively to 1.69 ± 1.04 D postoperatively. The mean maximum K value decreased from 48.09 ± 2.56 D to 44.17 ± 2.67 D and the mean minimum K value, from 44.90 ± 2.54 D to 42.46 ± 2.63 D. All changes were statistically significant (P<.0001). CONCLUSION: Intrastromal corneal ring segments effectively reduced corneal cylinder in patients with astigmatism after PKP.

Intrastromal corneal ring segments: visual outcomes from a large case series.

BACKGROUND: To evaluate the clinical safety and efficacy of implanted Ferrara intrastromal corneal ring segments in a large sample of patients with ectatic corneal disease. DESIGN: Retrospective, consecutive case series. SAMPLES: A total of 1073 eyes of 810 patients consecutively operated from January 2006 to July 2008 were evaluated. METHODS: Two groups were created according to the type of ring implanted: Group 1 - patients implanted with the 160° of arc ring - and Group 2 - patients implanted with the 210° of arc ring. MAIN OUTCOME MEASURES: Uncorrected visual acuity, best-corrected visual acuity, keratometry, asphericity and pachymetry at the thinnest point of the cornea. All patients were evaluated using a corneal tomography (Pentacam, Oculus, Inc., Lynnwood, WA, USA). RESULTS: For Group 1 patients, uncorrected visual acuity increased to 20/80, best-corrected visual acuity increased to 20/40, asphericity decreased to -0.35, spherical equivalent decreased to -2.26 D and keratometry decreased to 45.72 D (P < 0.001 for each compared with preoperative values). For Group 2 patients, uncorrected visual acuity increased to 20/130, best-corrected visual acuity increased to 20/60, asphericity decreased to -0.56, spherical equivalent decreased to -4.14 D and keratometry decreased to 48.10 D (P < 0.001 for each compared with preoperative values). The 210° intrastromal corneal ring segments reduced keratometry and asphericity more than the 160° intrastromal corneal ring segments did. The complication rate was 3.82%. CONCLUSIONS: Ferrara intrastromal corneal ring segments implantation is safe and effective and has a low complication rate. It can effectively reduce the corneal steepening and improve uncorrected visual acuity and best-corrected visual acuity in patients with keratoconus.

SMase II, a new sphingomyelinase D from Loxosceles laeta venom gland: molecular cloning, expression, function and structural analysis.

Sphingomyelinase D (SMase D) present in the venoms of Loxosceles spiders is the principal component responsible for local and systemic effects observed in the loxoscelism. By using "expressed sequencing tag", it was possible to identify, in a L. laeta venom gland library, clones containing inserts coding for proteins with similarity to SMase D. One of these clones was expressed and the recombinant protein compared with the previously characterized SMase I from L. laeta, in terms of their biological, biochemical and structural properties. The new recombinant protein, SMase II, possesses all the biological properties ascribed to the whole venom and SMase I. SMase II shares 40% and 77% sequence similarity with SMase I and Lb3, respectively; the latter, a SMase D isoform from L. boneti, catalytically inactive. Molecular modeling and molecular dynamics simulations were employed to understand the structural basis, especially the presence of an additional disulfide bridge, in an attempt to account for the observed differences in SMases D activity.