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                  <mods:namePart>Monteiro, Tiago</mods:namePart>
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                  <mods:namePart>Mendes, José Ferreira</mods:namePart>
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                  <mods:namePart>Franqueira, Nuno</mods:namePart>
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                  <mods:namePart>Madrid Costa, David</mods:namePart>
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                  <mods:namePart>Alfonso, José F.</mods:namePart>
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                  <mods:dateAccessioned encoding="iso8601">2023-06-17T12:26:58Z</mods:dateAccessioned>
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               <mods:identifier type="issn">0277-3740</mods:identifier>
               <mods:identifier type="doi">10.1097/ICO.0000000000001449</mods:identifier>
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               <mods:abstract>Purpose: To evaluate visual, refractive, and corneal topography outcomes in eyes with keratoconus that have undergone exchange/adjustment surgery with a new intrastromal corneal ring segment (ICRS) combination after unsuccessful visual and/or refractive outcomes after primary ICRS surgery. Methods: A retrospective nonrandomized case series was conducted including consecutive eyes of patients with keratoconus that underwent ICRS adjustment after an unsuccessful visual outcome. Patients were divided into 2 groups: group 1 was made up of patients with Intacs ICRSs that were exchanged for the Ferrara ICRS type, and group 2 consisted of patients who maintained the same ICRS type after undergoing ICRS adjustment surgery (change of the arc length or thickness). Uncorrected distance visual acuity, best-corrected distance visual acuity (CDVA), keratometry, asphericity, higher-order aberrations, and corneal regularity indexes (ISV and IHD) (Pentacam HR; OCULUS) were assessed preoperatively and 12 months after each procedure. Results: Twenty-six eyes from 26 patients were included, 8 eyes in group 1 and 18 eyes in group 2. The eyes in both groups improved their CDVA values after ICRS exchange, in group 1 from 0.27 ± 0.11 preoperatively to 0.54 ± 0.17 postoperatively (P = 0.001), and in group 2 from 0.34 ± 0.22 to 0.61 ± 0.15 (P &lt; 0.0001). In both groups, there was also a significant improvement in the refractive cylinder, topographic cylinder, and coma after ICRS adjustment (P &lt; 0.05). Conclusions: ICRS implantation has been shown to be a reversible and adjustable surgical procedure for keratoconus treatment. Good outcomes can be obtained after ICRSs are exchanged. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved</mods:abstract>
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                  <mods:title>Adjustment of intrastromal corneal ring segments after unsuccessful implantation in keratoconic eyes</mods:title>
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