Sequential intracorneal ring segment implantation followed by transepithelial phototherapeutic keratectomy and corneal cross-linking.

PURPOSE: To evaluate the safety and visual outcomes of intrastromal corneal ring segment (ICRS) implantation followed by transepithelial phototherapeutic keratectomy (te-PTK) and corneal cross-linking (CXL) in patients with mild keratoconus. METHODS: Patients with mild keratoconus and contact lens intolerance who underwent sequential ICRS implantation followed by phototherapeutic keratectomy and corneal CXL between April 2015 and July 2018 were retrospectively included in the study. Refractive and visual outcomes, satisfaction questionnaire and complications were recorded at the last follow-up (mean 9.5 months postoperatively). RESULTS: Twenty eyes of 17 patients were enrolled, including 5 women and 15 men. The mean time between the two procedures was 16 months. Based on values before the first procedure and 9.5 months after the second procedure, significant improvements were noted in uncorrected distance visual acuity (UDVA) (0.80±0.35 logMAR vs. 0.46±0.38 logMAR), corrected distance visual acuity (CDVA) (0.38±0.23 logMAR vs. 0.13±0.16 logMAR), maximal K (56.11±4 diopters [D] vs. 50.6±3.56 D), mean K (51.87±3.43 D vs. 48.45±2.91 D), cylinder (7.99±3.94 D vs. 4.23±3.49 D), and spherical equivalent (-3.84±3.36 D vs. -0.99±2.15 D) (P<0.01). Among the outcomes, we noted 5 (25%) superficial corneal scarring (haze); 75% of eyes gained>=1 logMAR line of CDVA. In all, 94.5% of patients reported that they were satisfied with their outcomes. CONCLUSION: Combining ICRS implantation followed by te-PTK and corneal CXL appears to be a safe and effective approach for improving visual outcomes and quality of life in keratoconus patients.

Reproducibility of single-pass donor DSAEK tissue preparation with the MORIA single-use microkeratome.

PURPOSE: To assess the reproducibility of single-pass cutting for preparation of ultra-thin (≤120µm) donor cornea grafts in Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: All consecutive patients of DSAEK performed using the MORIA One Use microkeratome (MORIA, Antony, France) in between June 2014 and August 2015. Patient and donor central corneal thickness (CTT), microkeratome head, remaining stromal bed thickness (RSBT), number of cut and graft thickness at 1 month and 6 months postoperatively were recorded in this single-center prospective study. RESULTS: The mean preoperative donor graft CCT was 569.0±45.1µm and the mean donor endothelial graft CCT immediately after the cut was 116.5±28.7µm. At 1 month postoperatively, the mean CCT was 102.8±35.9µm. At 6 months, the mean CCT was 89.4±26.2µm. In all eyes, the mean CCT decreased from the post-cut (116.5±28.7µm) to the last visit (89.4±26.2µm) (P<0.01) due to in vivo deturgesence of the graft. We obtained 77.5% ultra-thin DSAEK immediately after the cut, 77.5% at 1 month and 89.8% after 6 months. CONCLUSION: Single-pass technique with the MORIA One Use microkeratome offers safe and reproducible DSAEK tissue preparation and allows achieving ultra-thin DSAEK in 89.8% of cases.

Use of a new, flexible lipidocolloid dressing on acute and chronic wounds: results of a clinical study.

OBJECTIVE: To document the performance (efficacy, tolerability and acceptability) of Urgotul Flex, a new, more flexible version of the lipidocolloid dressing Urgotul, in the management of acute and chronic wounds. Efficacy was defined as the reduction in ulcer surface area after 4 weeks of treatment. METHOD: This open, non-comparative, multicentre clinical trial recruited patients from 11 centres, which included surgical, burns and rehabilitation units and paediatric, geriatric and dermatology wards. Inclusion criteria were non-infected wounds of any aetiology that were <120cm2 in size. Ulcer surface area was assessed by tracing and planimetry. Acceptability parameters were: ease of dressing application; pain at dressing change; dressing adherence to wound bed and bleeding at removal; maceration of surrounding skin; these were all assessed qualitatively. Patients were followed up for a maximum of 4 weeks, or until they healed if this occurred first. Efficacy and tolerability were assessed by the physicians on a weekly basis, and acceptability by the nursing staff at each dressing change. All of the physicians/nurses had previously participated in clinical evaluations of Urgotul using the same outcomes and assessments, and so performed a retrospective assessment of the two dressings. RESULTS: Forty-four patients from 11 investigating centres were included in the study. The mean baseline surface area at was 21cm2 and 6cm2 for the acute and chronic wounds respectively. Twenty wounds (17 acute wounds and three chronic wounds) healed. Of the remainder, the mean surface area reduction was 78% and 42% for the acute and chronic wounds respectively at the end of the 4-week treatment period. Only two local adverse events were reported, but these were not considered to be dressing related. Based on the 345 documented dressing changes, conformability of the new dressing was considered to be superior to that of Urgotul, particularly when used on acute wounds. CONCLUSION: These findings show that the efficacy and tolerability of Urgotul Flex is similar to that reported in previous observational studies on Urgotul. However, results show it is more flexible and thus more conformable, particularly when used on wounds in awkward locations, including paediatric wounds and hand surgery. CONFLICT OF INTEREST: This evaluation was sponsored by Laboratoires URGO, Chenôve, France.