Topographic Pattern-Based Nomogram to Guide Keraring Implantation in Eyes with Mild to Moderate Keratoconus: Visual...

Background: To assess the outcome of Keraring (Mediphacos, Brazil) implantation according to a topographic pattern-based nomogram in eyes with mild to moderate keratoconus. Materials and Methods: A topographic pattern-based nomogram was used to guide Keraring selection in 47 consecutive eyes with stage I-II keratoconus (Amsler-Krumeich staging), which underwent femtosecond laser-assisted implantation at a single center. Electronic data of LogMar uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) manifest refraction and tomographic analysis (Pentacam HR, Oculus, Germany) measured preoperatively and at the last postoperative examination were retrospectively analyzed. Results: Mean follow-up was 18.8 months. (range 3-35). Mean UDVA improved (p < 0.001) from 0.87 ± 0.27 to 0.35 ± 0.21. UDVA increased on average by 5.13 lines. Mean CDVA improved from 0.21 ± 0.10 to 0.09. ± 0.07, and the proportion of eyes with CDVA ≥ 20/25 increased from 29.8% to 85.1% after surgery. No eyes lost lines of CDVA. The Alpins correction index of astigmatism was 0.77 and the mean refractive cylinder decreased from 4.99 ± 1.89 to -2.31 ± 1.47 D (p < 0.001). Mean and maximal keratometry was reduced on average by -2.10 ± 1.42 D and -3.02 ± 3.68 D, respectively (p < 0.001). The RMS of corneal high-order aberrations dropped from 3.296 ± 1.180 µm to 2.192 ± 0.919 µm, and that of vertical coma from -2.656 ± 1.189 µm to -1.427 ± 1.024 µm (p < 0.001). All topometric indices improved after surgery. Conclusions: Planning Keraring implantation using the topographic pattern-based nomogram is very effective and safe in eyes with mild to moderate keratoconus. Using that nomogram of UDVA and CDVA are clinically significant.