Visual perception changes and optical stability after intracorneal ring segment implantation: comparison between 3 months and 1 year after surgery

Juliane de Freitas Santos Paranhos, Marcos Pereira Ávila, Augusto Paranhos Jr, Paulo Schor
Federal University of São Paulo, São Paulo, Brazil

Purpose: To prospectively evaluate intracorneal ring segment (ICRS) implantation on quality of life (QoL) of patients with keratoconus changes and identify factors responsible.
Methods: Sixty-nine eyes of 42 keratoconus patients were implanted with the Keraring (Mediphacos, Belo Horizonte, Brazil). Best corrected visual acuity (BCVA), refraction, and steep keratometry were analyzed 3 months and 1 year after surgery. All patients self-administered the National Eye Institute Refractive Error Quality of life instrument at 2 time points: after having worn best correction for at least 30 days since evaluation (mean 4 months after surgery) and 1 year after surgery. To analyze if the use of the appropriate correction at 1 year follow up had any impact on visual acuity and V-QoL, patients were divided into 2 groups: group A (appropriate correction) and B (not appropriate correction).
Results: After 1 year, QoL changes related to scales ‘clarity of vision’, ‘near vision’, and ‘far vision’. Keratometric values, sphere, and spherical equivalent did not differ significantly between 3 months and 1 year postoperative. Cylinder increase was statistically but not clinically significant. Binocular BCVA did not change 1 year after surgery in group A and showed a clinically significant impairment in group B. A year after surgery, 18 patients did not use correction suggested by a physician 3 months after surgery. QoL was not statistically different 1 year after surgery between group A and group B.
Conclusion: Our findings show that the way keratoconic patients see is difficult to analyze using only quantitative and 1-visit metrics. They highlight the importance of patients’ self perception and performing longitudinal analysis to consider neural compensation to optical changes from surgery.

Keywords: keratoconus, cornea, quality of life