July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Implantation of Intrastromal Allograft Corneal Segment (ISACS) for treatment of pellucid marginal degeneration (PMD)
Author Affiliations & Notes
  • Mohammad Jafarinasab
    labbafinejad Medical Center,Department of Ophthalmology, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
    Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  • Mohammadali Javadi
    labbafinejad Medical Center,Department of Ophthalmology, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
    Eye BankManagement, Iran (the Islamic Republic of)
  • Sare Safi
    labbafinejad Medical Center,Department of Ophthalmology, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
    Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
  • Hamed Abbasi
    labbafinejad Medical Center,Department of Ophthalmology, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
  • Yasaman Hadi
    labbafinejad Medical Center,Department of Ophthalmology, Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Tehran, Iran (the Islamic Republic of)
  • Footnotes
    Commercial Relationships   Mohammad Jafarinasab, None; Mohammadali Javadi, None; Sare Safi, None; Hamed Abbasi, None; Yasaman Hadi, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 6310. doi:
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    • Get Citation

      Mohammad Jafarinasab, Mohammadali Javadi, Sare Safi, Hamed Abbasi, Yasaman Hadi; Implantation of Intrastromal Allograft Corneal Segment (ISACS) for treatment of pellucid marginal degeneration (PMD). Invest. Ophthalmol. Vis. Sci. 2019;60(9):6310.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Management of pellucid marginal degeneration (PMD) is a subject of ongoing research in the field of corneal ectasia. There is no universally accepted method for managing these patients, especially subjects who cannot wear any type of contact lens. In the current pilot study we introduce a new surgical method for management of thinning and high irregular astigmatism due to PMD.

Methods : In this prospective study, we implanted allograft Intrastromal corneal segment (ISACS)in four eyes of 3 patients with PMD as a new surgical procedure. A femtosecond laser-assisted stromal canal 4 mm in width was created in the 5.5 to 9.5 mm corneal zone.
An ISACS was implanted in the canals. A new handmade spatula was used for implantation (will show in video). Dimensions of the implanted ISACS were ring shaped with width of 2 mm and arc length of 160,and 210 degree in two eyes and crescent shaped with maximum width of 3mm and arc length of 180 degree in two eyes.The Thickness of all segments were 350 micron.
The arc lengths, width and shape were determined based on the area of inferior steepening.

Results : Uncorrected visual acuity and best-corrected visual acuity was improved after surgery in all eyes on all examination.
Both myopia and astigmatism were reduced in all cases and were stable during 9 months follow up.
The steep areas were displaced superiorly and the amount of irregular astigmatism was reduced on topography (included Figure).
Implanted ISACSs were clear and stable on the day after implantation and thereafter on all examinations during the follow up period.
No significant side effect or complication was observed during the nine month follow up period.

Conclusions : ISACS is a safe, effective and inexpensive method for management of PMD, with advantages of customized shape (ring segment, crescent shaped), width and arch length. Longer follow up and larger sample size are needed to confirm our findings.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Refraction and topography changes from preop (Left) and 9 month after implantation of the Intrastromal Allograft Corneal Segment (ISACS) ,(Right) in the first patient.

Refraction and topography changes from preop (Left) and 9 month after implantation of the Intrastromal Allograft Corneal Segment (ISACS) ,(Right) in the first patient.

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