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Doctor´s Tips

Dr. Gustavo Nery


6 mm diameter Ferrara Ring™ segments

 

With the introduction of Femtosecond Laser Assisited Surgery for Ferrara Ring implants, which made the procedure safer and more reproductive, we are increasingly working on initial keratoconus! And the 6mm ring started to gain more space, once we are operating patients with relatively good vision, we want to bother as little as possible in the matter of glare and halos! The union of operating a more initial keratoconus with the segments farther from the pupillary border gives the procedure "almost" a refractive surgery status, if it is possible to say that in Intra Corneal Ring surgery! The 6mm segments has a different mechanism of action than the 5mm segments, which will always be the most used, and understanding this is critical to the success of the patient's final refraction!

The ring has a more peripheral action and may even increase the central curvature of the cone and should be used in more initial cases (center k <52 D)

Other good indications are also:

  • Large mesopic pupils> 4 mm
  • Secondary Refractive Procedure Plan (PRK OR FACILITY)


FERRARA RING™


In 1998, Dr. Paulo Ferrara taught the first Course on Intrastromal Corneal Ring Segment (ICRS) Implantation for the correction of keratoconus.
Nowadays, this technology is present in 87 countries amounting to over 600.000 eye implants.

With the technological development, the diagnosis and the surgical technique are extremely precise, guaranteeing the correct indication and reproducibility of results.

Life Quality for keratoconus patients.

GUIDELINES AND CARE

 

The product is manufactured in a "Clean Room" where the conditions of static energy of the environment can leave the product electrostatically charged, also considering the possibility of moving the product during transportation and handling.

Looking for information with the manufacturer AJL as well as with the commercial department of Ferrara Ophthalmics, we point out some extremely important guidelines and care at the moment of use:

  • Open the case slowly and carefully in the surgical field;
  • Check the presence of the segment in the case. If not, check that it is adhered to the cover of the case due to the static factor already mentioned;
  • Pinch the segment with specific instruments


Surgical Planning


To request a customized surgical planning , it will be necessary to send the topography or corneal tomography examinations for analysis of the Ferrara Ophthalmics clinical staff.

We will forward the suggestions for surgical planning as soon as possible, depending only on the availability of the doctors responsible for its elaboration.

Forms of standardization of the Tomographic exams
Download the PDF for your device


SUBMIT PRE-OPERATIVE EXAMS




Scientific Articles




Clinical Results


LONG-TERM FOLLOW-UP IN KERATOCONUS
In a retrospective review, files of patients operated with Ferrara Ring Implants were reviewed because they were intolerant to contact lenses and / or showed progression of ectasia.

All these patients completed at least two years of clinical follow-up without presenting any complications during the procedures.

It was verified that the main keratometry decreased considerably from the first preoperative examination to the last postoperative examination, as well as the central flattening of the cornea and repositioning of the refractive center. As shown in previous studies, the intracorneal ring levels the cornea and maintains its effect over a long period. In addition, there was no significant change in cone evolution over time.

The present study demonstrated that the Ferrara Ring can be a valuable tool for establishing topographic and visual stability, delaying the progression of keratoconus, and postponing corneal transplant surgery.
CONTACT LENS AFTER FERRARA RING IMPLANTATION
The fitting of contact lenses is considerably facilitated after the Ferrara Ring Implant.

Since regularization of the surface of the cornea occurs with reduction of excessive delivery, most patients adapt well to contact lenses in the postoperative period.

The adaptation of contact lenses should not occur until 3 months of follow-up, which is the period necessary for the stabilization of refraction and keratometry. It is common for patients previously intolerant to rigid gas penetrating contact lenses to fit well in the post-implant. It is often possible to adapt gelatinous lenses.

In addition, there is excellent post-surgical stability by decreasing the chance of "lens loss" caused by instability, a common complaint before surgery and no longer seen.
THE 210 FERRARA RING
(210 FICR) The Intraestromal Ring of Ferrara with 210º of arc has 3 important advantages over the conventional ring.

1) Minimum induction to astigmatism;
2) Corneal malformation;
3) Implantation of a single segment.

This ring is extremely effective for nipple type keratoconus. The 210-IFRC is an efficient method for the correction of keratoconus with significant reduction of keratometric values ​​and improvement of spherical equivalent UCVA and BCVA.
We analyzed files from 80 eyes of 76 patients, using the Implant of the 210-FICR.

The mean follow-up of these patients was 6.65 months.
Topographic examinations (Pentacam) demonstrated flattening of the cornea in all eyes.
POST- REFRACTIVE SURGICAL CORNEAL ECTASIA
25 eyes of 20 patients with corneal ectasia submitted to the Ferrara Ring Implant were included in the study. The mean follow-up time was 39.8 +/- 21.1 months.

Postoperative results showed a significant improvement in both UCVA and CDVA. In addition, there was a significant increase in corneal thickness.
There was a significant decrease in the values ​​of asfericities after the Ferrara Ring Implant.

Values ​​of keratometries were significantly reduced in all eyes.
It can be observed that the main preoperative values ​​are usually smaller than those found in primary keratoconus. This can be explained, among other things, by induction to the corneal flattening given the refractive procedure, usually in the optical zone with a larger diameter than ectasia.

The potential advantages of the Implants (ICRS) on corneal transplantation in eyes with post-LASIK ectasia are many. First it avoids later treatments with the laser, eliminating corneal healing. This leaves the center of the cornea untouched, increasing the refractive result.

In addition, the technique is reversible in cases of unsatisfactory correction or with few clinical outcomes, and postoperative care is minimal. Correction adjustments can be made by varying the thickness of the Ring and in case of unexpected changes in the shape of the cornea when only one segment can be removed or replaced.

Finally, Ferrara's Ring Implants eliminate complications in more invasive surgeries.
COMPLICATIONS
The incidence of surgical complications after the learning curve is small.

Postoperative complications may be related to:

1) Surgical technique;
2) Nomogram
3) Ring

Regarding the surgical technique, extrusion can be observed due to superficial tunneling; infection; poor segment focus; migration; asymmetry of the positioning of the rings.

Complications related to the nomogram are linked to corneal biomechanics and may be hypocorrection and hypercorrection. Although there is predictability of the postoperative result, some cases of hypo or hypercorrection may occur due to the viscoelasticity and the biomechanical profile of the different corneas with keratoconus.

As for the ring may occur glare, reported by 10% of patients, may be related to pupil size and tend to decrease over time; perianellar deposits; neovascularization of the stromal tunnel that occur rarely in atopic patients. Subvariable Bevacizumab is used for the treatment of this complication with reasonable results as portrayed in the literature.

TRAINING


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