Eyeworld

SEPTEMBER 2023 | EYEWORLD | 59 C Contact Dockery: phildock2020@gmail.com Jacob: dr_soosanj@hotmail.com Kiliç: aylinkilicdr@gmail.com Relevant disclosures Dockery: None Jacob: Patent granted for special trephines and devices used to create these segments, patent pending for CAIRS segments and various types of shaped corneal segments, Madhu Instruments, Ziemer Ophthalmic Systems Kiliç: VisionGift improved safety, while having a greater impact of improving corneal shape. He also said CAIRS can be used in more advanced cases. "We've implanted some of these segments in eyes with a Kmax in the 90s even," he said. He added that he has seen more flattening with CAIRS than with synthetic segments. "Some eyes will see even 20–30 D of flatten- ing, which is much more. However, what we've realized is that the level of flattening is not always predictive of the level of visual acuity improvement or the quality of improvement of vision," he said. "The thing we're looking at now is we're seeing a significant decrease in higher order aberrations after CAIRS implantation … making the quality of vision better and making these corneas possibly more refractable." Dr. Kiliç was involved in the development of KeraNatural (VisionGift), which she described as an allogenic corneal inlay that is obtained from VisionGift eye banks and packaged in a process that is shelf stable for 2 years. "It is amazing. … It is packaged like a contact lens," she said. Dr. Kiliç described the Istanbul protocol, which includes implanting the KeraNatural tissue into femtosecond laser-created tunnels, followed by crosslinking if keratoconus is pro- gressive. She said that segment length can be customized based on the topographic regular- ization that's needed, and more than one seg- ment can be used as well. This protocol that was published was a pilot study in 2022, showing an increase of CDVA from a mean of 0.29±0.20 preop to 0.56±0.26 post-KeraNatural. 5 A more recent retrospective, non-random- ized study of 65 keratoconic eyes of 49 con- secutive patients (mean age 29.5±7.3 years) found KeraNatural helped improve UCVA from 0.91±0.50 logMAR preop to 0.40±0.24 logMAR at 6-months postop; CDVA improved from 0.87±0.20 logMAR preop to 0.27±0.06 logMAR postop. 6 Average keratometry de- creased from 49.23±5.22 to 45.63±4.89 D with KeraNatural. The investigators reported that mean anterior and posterior maximum eleva- tions significantly decreased as well. "This study demonstrated that implantation of corneal allograft ring segments is a viable al- ternative treatment for keratoconus with safety and good visual results," Nacaroglu et al. wrote. Dr. Kiliç said efficacy is similar to synthet- ic intracorneal ring segments but without the complications. "This is extremely safe biolog- ic tissue," she said. "We think it is safer than keratoplasty. It's a 5- to 10-minute procedure. It's reversible. It's adjustable. I think all kerato- conus patients should be given a chance with KeraNatural. "My mission is to stop keratoplasty for keratoconus in the world. [The KeraNatural] allograft tissue is from one cornea and we can obtain so many; so many keratoconus patients can benefit," Dr. Kiliç said later. *This list may not be comprehensive of all syn- thetic intracorneal ring segment products. Keratoconus cases 6 months after KeraNatural implantation Source: Aylin Kiliç, MD

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