{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:27:20Z","timestamp":1759336040874,"version":"build-2065373602"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"},{"start":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T00:00:00Z","timestamp":1756252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"}],"funder":[{"name":"Universit\u00e4tsklinikum des Saarlandes und Medizinische Fakult\u00e4t der Universit\u00e4t des Saarlandes"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ophthalmologie"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n          <jats:sec>\n            <jats:title>Ziel<\/jats:title>\n            <jats:p>Analyse des Visus, der Keratometrie und der Aberrometrie (Koma) nach ICRS-Implantation bei Keratokonus (KK) bzw. der Visusentwicklung nach sequenziell notwendiger Excimerlaser-assistierter perforierender Keratoplastik (PKP).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patienten und Methoden<\/jats:title>\n            <jats:p>Retrospektive Analyse einer Fallserie von 7\u00a0Patienten aus dem Homburger Keratokonus Center (HKC), die 3,2\u202f\u00b1\u20093,0\u00a0Jahre nach ICRS-Implantation bei nicht zufriedenstellendem Visus eine Excimerlaser-PKP erhielten. Neben dem unkorrigierten (UCVA) und bestkorrigierten (BCVA) Fernvisus in logMAR wurden die flache (K1), steile (K2), mittlere Keratometrie (Kmean), die Higher Order Aberrations (HOA, Koma) sowie die Regularit\u00e4t des Astigmatismus mittels Tomographie analysiert. Die Daten der PKP-Gruppe (PG) wurden mit einer Kontrollgruppe (KG) von 7\u00a0altersadaptierten, zufriedenen ICRS-Patienten ohne PKP-Notwendigkeit verglichen. Die Datenerhebung erfolgte vor und 7,4\u202f\u00b1\u20094,5\u00a0Monate nach PKP.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Ergebnisse<\/jats:title>\n            <jats:p>Vor PKP zeigte sich eine signifikant schlechtere UCVA von 0,94\u202f\u00b1\u20090,54 und BCVA von 0,49\u202f\u00b1\u20090,07 in der PG im Vergleich zur KG (UCVA 0,40\u202f\u00b1\u20090,35; BCVA 0,06\u202f\u00b1\u20090,05, <jats:italic>p<\/jats:italic>\u202f&lt;\u20090,01). K1 war in der PG vor PKP signifikant h\u00f6her (47,1\u202f\u00b1\u20093,1 vs.\u00a043,0\u202f\u00b1\u20092,7\u00a0D) als in der KG (<jats:italic>p<\/jats:italic>\u202f=\u20090,02), K2 (<jats:italic>p<\/jats:italic>\u202f=\u20090,86) und Kmean (<jats:italic>p<\/jats:italic>\u202f=\u20090,12) nicht. Die Regularit\u00e4t des peripheren (<jats:italic>p<\/jats:italic>\u202f=\u20090,54) und zentralen Astigmatismus (<jats:italic>p<\/jats:italic>\u202f=\u20090,69) sowie die Koma (<jats:italic>p<\/jats:italic>\u202f=\u20090,39) unterschieden sich pr\u00e4operativ zwischen den Gruppen nicht. Die Excimerlaser-PKP war bei allen 7\u00a0Augen wie gewohnt m\u00f6glich. Sieben Monate nach komplikationsloser PKP trotz liegender ICRS zeigte sich schon bei liegenden F\u00e4den ein signifikanter Visusanstieg (BCVA) von 0,49\u202f\u00b1\u20090,07 auf 0,33\u202f\u00b1\u20090,1 (<jats:italic>p<\/jats:italic>\u202f&lt;\u20090,001). Auch K1 verringerte sich nach PKP signifikant (<jats:italic>p<\/jats:italic>\u202f=\u20090,002).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Schlussfolgerungen<\/jats:title>\n            <jats:p>Patienten nach erfolgloser ICRS-Implantation zeigten neben schlechtem Visus eine h\u00f6here K1 bei \u00e4hnlichen Werten f\u00fcr K2, Kmean und Koma. Diese Patienten profitieren von einer Excimerlaser-PKP, die trotz liegender ICRS problemlos m\u00f6glich ist.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00347-025-02309-4","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T13:59:40Z","timestamp":1756303180000},"page":"819-825","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Die Excimerlaser-assistierte Keratoplastik ist erfolgreich im Management komplizierter F\u00e4lle von intrakornealen Ringsegmenten beim Keratokonus","Excimer laser-assisted keratoplasty is successful in the management of complex cases of intracorneal ring segments in keratoconus"],"prefix":"10.1007","volume":"122","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7912-023X","authenticated-orcid":false,"given":"P.","family":"Teping","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Hamon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.","family":"Seitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Daas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,8,27]]},"reference":[{"key":"2309_CR1","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1097\/ICO.0000000000002327","volume":"39","author":"R Alfaro Rangel","year":"2020","unstructured":"Alfaro Rangel\u00a0R, Szentmary\u00a0N, Lepper\u00a0S et\u00a0al (2020) 8.5\/8.6-mm Excimer Laser-Assisted Penetrating Keratoplasties in a\u00a0Tertiary Corneal Subspecialty Referral Center: Indications and Outcomes in 107 Eyes. Cornea 39:806\u2013811","journal-title":"Cornea"},{"key":"2309_CR2","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1016\/j.jcrs.2009.07.008","volume":"35","author":"E Coskunseven","year":"2009","unstructured":"Coskunseven\u00a0E, Jankov\u00a0MR 2nd, Hafezi\u00a0F et\u00a0al (2009) Effect of treatment sequence in combined intrastromal corneal rings and corneal collagen crosslinking for keratoconus. J\u00a0Cataract Refract Surg 35:2084\u20132091","journal-title":"J Cataract Refract Surg"},{"key":"2309_CR3","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1111\/j.1755-3768.2009.01605.x","volume":"89","author":"E Coskunseven","year":"2011","unstructured":"Coskunseven\u00a0E, Kymionis\u00a0GD, Tsiklis\u00a0NS et\u00a0al (2011) Complications of intrastromal corneal ring segment implantation using a\u00a0femtosecond laser for channel creation: a\u00a0survey of 850 eyes with keratoconus. Acta Ophthalmol 89:54\u201357","journal-title":"Acta Ophthalmol"},{"key":"2309_CR4","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1097\/ICO.0000000000003703","volume":"44","author":"L Daas","year":"2025","unstructured":"Daas\u00a0L, Aljundi\u00a0W, Abdin\u00a0AD et\u00a0al (2025) Excimer Laser-Assisted Deep Anterior Lamellar Keratoplasty Versus Penetrating Keratoplasty for Patients With Keratoconus: A\u00a0Retrospective Analysis From the Homburg Keratoconus Center. Cornea 44:291\u2013299","journal-title":"Cornea"},{"key":"2309_CR5","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1007\/s00347-021-01342-3","volume":"118","author":"L Daas","year":"2021","unstructured":"Daas\u00a0L, Hamon\u00a0L, Ardjomand\u00a0N et\u00a0al (2021) Excimerlaser-gest\u00fctzte DALK: Ein Fallbericht aus dem Homburger Keratokonus Center (HKC). Ophthalmologe 118:1245\u20131248","journal-title":"Ophthalmologe"},{"key":"2309_CR6","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1055\/s-0042-108653","volume":"233","author":"M El-Husseiny","year":"2016","unstructured":"El-Husseiny\u00a0M, Daas\u00a0L, Langenbucher\u00a0A et\u00a0al (2016) Intrakorneale Ringsegmente bei Keratektasien \u2013 Zwischenergebnisse und potenzielle Komplikationen. Klin Monbl Augenheilkd 233:722\u2013726","journal-title":"Klin Monbl Augenheilkd"},{"key":"2309_CR7","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1007\/s00347-013-2821-2","volume":"110","author":"M El-Husseiny","year":"2013","unstructured":"El-Husseiny\u00a0M, Tsintarakis\u00a0T, Eppig\u00a0T et\u00a0al (2013) Intrakorneale Ringsegmente beim Keratokonus. Ophthalmologe 110:823\u2013826 (828\u2013829)","journal-title":"Ophthalmologe"},{"key":"2309_CR8","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1016\/j.jcrs.2007.02.048","volume":"33","author":"A Ertan","year":"2007","unstructured":"Ertan\u00a0A, Colin\u00a0J (2007) Intracorneal rings for keratoconus and keratectasia. J\u00a0Cataract Refract Surg 33:1303\u20131314","journal-title":"J Cataract Refract Surg"},{"key":"2309_CR9","doi-asserted-by":"publisher","first-page":"970","DOI":"10.1016\/j.jcrs.2009.12.042","volume":"36","author":"C Ferrer","year":"2010","unstructured":"Ferrer\u00a0C, Alio\u00a0JL, Montanes\u00a0AU et\u00a0al (2010) Causes of intrastromal corneal ring segment explantation: clinicopathologic correlation analysis. J\u00a0Cataract Refract Surg 36:970\u2013977","journal-title":"J Cataract Refract Surg"},{"key":"2309_CR10","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1097\/ICO.0b013e318183a40c","volume":"28","author":"L Fontana","year":"2009","unstructured":"Fontana\u00a0L, Parente\u00a0G, Sincich\u00a0A et\u00a0al (2009) Deep anterior lamellar keratoplasty after Intacs implantation in patients with keratoconus. Cornea 28:32\u201335","journal-title":"Cornea"},{"key":"2309_CR11","doi-asserted-by":"publisher","first-page":"2524","DOI":"10.1016\/j.jcrs.2015.06.027","volume":"41","author":"EO Graue-Hernandez","year":"2015","unstructured":"Graue-Hernandez\u00a0EO, Pagano\u00a0GL, Garcia-De La Rosa\u00a0G et\u00a0al (2015) Combined small-incision lenticule extraction and intrastromal corneal collagen crosslinking to treat mild keratoconus: Long-term follow-up. J\u00a0Cataract Refract Surg 41:2524\u20132532","journal-title":"J Cataract Refract Surg"},{"key":"2309_CR12","doi-asserted-by":"publisher","first-page":"2299","DOI":"10.1007\/s00417-022-05572-2","volume":"260","author":"L Hamon","year":"2022","unstructured":"Hamon\u00a0L, Schl\u00f6tzer-Schrehardt\u00a0U, Flockerzi\u00a0FA et\u00a0al (2022) Morphological characterization and clinical effects of stromal alterations after intracorneal ring segment implantation in keratoconus. Graefes Arch Clin Exp Ophthalmol 260:2299\u20132308","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"2309_CR13","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.jfo.2021.06.018","volume":"45","author":"L Hamon","year":"2022","unstructured":"Hamon\u00a0L, Seitz\u00a0B, Daas\u00a0L (2022) Intrastromal fibrosis and lipid deposits twenty years after intracorneal ring segments implantation for treatment of mild myopia. J\u00a0Fr Ophtalmol 45:147\u2013150","journal-title":"J Fr Ophtalmol"},{"key":"2309_CR14","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1097\/01.ico.0000167883.63266.60","volume":"25","author":"AJ Kanellopoulos","year":"2006","unstructured":"Kanellopoulos\u00a0AJ, Pe\u00a0LH, Perry\u00a0HD et\u00a0al (2006) Modified intracorneal ring segment implantations (INTACS) for the management of moderate to advanced keratoconus: efficacy and complications. Cornea 25:29\u201333","journal-title":"Cornea"},{"key":"2309_CR15","doi-asserted-by":"publisher","first-page":"2757","DOI":"10.4103\/ijo.IJO_1841_20","volume":"68","author":"VP Kankariya","year":"2020","unstructured":"Kankariya\u00a0VP, Dube\u00a0AB, Grentzelos\u00a0MA et\u00a0al (2020) Corneal cross-linking (CXL) combined with refractive surgery for the comprehensive management of keratoconus: CXL plus. Indian J Ophthalmol 68:2757\u20132772","journal-title":"Indian J Ophthalmol"},{"key":"2309_CR16","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.1016\/j.jcrs.2011.03.041","volume":"37","author":"T Koller","year":"2011","unstructured":"Koller\u00a0T, Pajic\u00a0B, Vinciguerra\u00a0P et\u00a0al (2011) Flattening of the cornea after collagen crosslinking for keratoconus. J\u00a0Cataract Refract Surg 37:1488\u20131492","journal-title":"J Cataract Refract Surg"},{"key":"2309_CR17","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1016\/j.ophtha.2016.01.010","volume":"123","author":"GA Kontadakis","year":"2016","unstructured":"Kontadakis\u00a0GA, Kankariya\u00a0VP, Tsoulnaras\u00a0K et\u00a0al (2016) Long-Term Comparison of Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Cross-linking versus Corneal Cross-linking Alone. Ophthalmology 123:974\u2013983","journal-title":"Ophthalmology"},{"key":"2309_CR18","doi-asserted-by":"publisher","first-page":"S807","DOI":"10.3928\/1081597X-20090813-09","volume":"25","author":"GD Kymionis","year":"2009","unstructured":"Kymionis\u00a0GD, Kontadakis\u00a0GA, Kounis\u00a0GA et\u00a0al (2009) Simultaneous topography-guided PRK followed by corneal collagen cross-linking for keratoconus. J\u00a0Refract Surg 25:S807\u2013811","journal-title":"J Refract Surg"},{"key":"2309_CR19","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.jcrs.2018.09.021","volume":"45","author":"N Nguyen","year":"2019","unstructured":"Nguyen\u00a0N, Gelles\u00a0JD, Greenstein\u00a0SA et\u00a0al (2019) Incidence and associations of intracorneal ring segment explantation. J\u00a0Cataract Refract Surg 45:153\u2013158","journal-title":"J Cataract Refract Surg"},{"key":"2309_CR20","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1016\/j.ophtha.2009.05.016","volume":"116","author":"DP Pinero","year":"2009","unstructured":"Pinero\u00a0DP, Alio\u00a0JL, El Kady\u00a0B et\u00a0al (2009) Refractive and aberrometric outcomes of intracorneal ring segments for keratoconus: mechanical versus femtosecond-assisted procedures. Ophthalmology 116:1675\u20131687","journal-title":"Ophthalmology"},{"key":"2309_CR21","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.jcrs.2006.08.059","volume":"33","author":"S Samimi","year":"2007","unstructured":"Samimi\u00a0S, Leger\u00a0F, Touboul\u00a0D et\u00a0al (2007) Histopathological findings after intracorneal ring segment implantation in keratoconic human corneas. J\u00a0Cataract Refract Surg 33:247\u2013253","journal-title":"J Cataract Refract Surg"},{"key":"2309_CR22","doi-asserted-by":"publisher","first-page":"2165","DOI":"10.1016\/j.jcrs.2015.03.020","volume":"41","author":"TG Seiler","year":"2015","unstructured":"Seiler\u00a0TG, Fischinger\u00a0I, Koller\u00a0T et\u00a0al (2015) Superficial corneal crosslinking during laser in situ keratomileusis. J\u00a0Cataract Refract Surg 41:2165\u20132170","journal-title":"J Cataract Refract Surg"},{"key":"2309_CR23","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1007\/s00347-019-00990-w","volume":"116","author":"B Seitz","year":"2019","unstructured":"Seitz\u00a0B, Daas\u00a0L, Milioti\u00a0G et\u00a0al (2019) Excimerlaser-assistierte perforierende Keratoplastik: Am 01.07.2019 feierte die perforierende Excimerlaserkeratoplastik ihren 30.\u00a0Geburtstag. Videobeitrag. Ophthalmologe 116:1221\u20131230","journal-title":"Ophthalmologe"},{"key":"2309_CR24","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1097\/ICO.0000000000001420","volume":"37","author":"B Seitz","year":"2018","unstructured":"Seitz\u00a0B, Hager\u00a0T, Langenbucher\u00a0A et\u00a0al (2018) Reconsidering Sequential Double Running Suture Removal After Penetrating Keratoplasty: A\u00a0Prospective Randomized Study Comparing Excimer Laser and Motor Trephination. Cornea 37:301\u2013306","journal-title":"Cornea"},{"key":"2309_CR25","doi-asserted-by":"publisher","first-page":"1156","DOI":"10.1016\/S0161-6420(99)90265-8","volume":"106","author":"B Seitz","year":"1999","unstructured":"Seitz\u00a0B, Langenbucher\u00a0A, Kus\u00a0MM et\u00a0al (1999) Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty. Ophthalmology 106:1156\u20131164","journal-title":"Ophthalmology"},{"key":"2309_CR26","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1177\/1120672119887874","volume":"31","author":"IP Sharma","year":"2021","unstructured":"Sharma\u00a0IP, Bakshi\u00a0R, Chaudhry\u00a0M (2021) Corneal collagen cross-linking with and without simultaneous intrastromal corneal ring segment implantation: One-year pilot study. Eur J Ophthalmol 31:61\u201368","journal-title":"Eur J Ophthalmol"},{"key":"2309_CR27","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1097\/ICO.0000000000002937","volume":"41","author":"AK Struckmeier","year":"2022","unstructured":"Struckmeier\u00a0AK, Hamon\u00a0L, Flockerzi\u00a0E et\u00a0al (2022) Femtosecond Laser and Mechanical Dissection for ICRS and MyoRing Implantation: A\u00a0Meta-Analysis. Cornea 41:518\u2013537","journal-title":"Cornea"},{"key":"2309_CR28","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s40662-016-0040-z","volume":"3","author":"A Vega-Estrada","year":"2016","unstructured":"Vega-Estrada\u00a0A, Alio\u00a0JL (2016) The use of intracorneal ring segments in keratoconus. Eye Vis (lond) 3:8","journal-title":"Eye Vis (lond)"},{"key":"2309_CR29","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.ophtha.2008.09.048","volume":"116","author":"P Vinciguerra","year":"2009","unstructured":"Vinciguerra\u00a0P, Albe\u00a0E, Trazza\u00a0S et\u00a0al (2009) Refractive, topographic, tomographic, and aberrometric analysis of keratoconic eyes undergoing corneal cross-linking. Ophthalmology 116:369\u2013378","journal-title":"Ophthalmology"}],"container-title":["Die Ophthalmologie"],"original-title":[],"language":"de","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00347-025-02309-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00347-025-02309-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00347-025-02309-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T08:31:37Z","timestamp":1759307497000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00347-025-02309-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,27]]},"references-count":29,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["2309"],"URL":"https:\/\/doi.org\/10.1007\/s00347-025-02309-4","relation":{},"ISSN":["2731-720X","2731-7218"],"issn-type":[{"type":"print","value":"2731-720X"},{"type":"electronic","value":"2731-7218"}],"subject":[],"published":{"date-parts":[[2025,8,27]]},"assertion":[{"value":"23 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 June 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 July 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Einhaltung ethischer Richtlinien"}},{"value":"P.\u00a0Teping, L.\u00a0Hamon, B.\u00a0Seitz und L.\u00a0Daas geben an, dass kein Interessenkonflikt besteht.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Interessenkonflikt"}},{"value":"F\u00fcr diesen Beitrag wurden von den Autor\/-innen keine Studien an Menschen oder Tieren durchgef\u00fchrt. F\u00fcr die aufgef\u00fchrten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Interessenkonflikt"}}]}}