Single Inferior Intac Insertion for Inferior Keratoconus

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Presentation transcript:

Single Inferior Intac Insertion for Inferior Keratoconus James Genge MD Vision Eye Institute Southline Sydney Australia No Financial Interest to disclose

Purpose To investigate the effectiveness of a single inferior Intac segment for inferior keratoconus Rationale was to harness the flattening effect of the Intac segment by placement in the area of maximal steepness noted on corneal topography Entrance incision positioned to allow adequate distance from Intac segment to minimise extrusion risk.

Study } Asymmetry > 4 D, select 0.45mm segment Indications Demographics N = 46 Average age 35 65% Male 35% Female 0.45mm Intac 76% 0.40mm Intac 24% Indications K’s < 55 No central scarring Inferior corneal thickness > 430 Post op follow up for 6 months assessing: UCVA BSCA Change in keratometry Change in Inferior: Superior ratio index Complications } Asymmetry > 4 D, select 0.45mm segment

Method Corneal center marked Intralase created channel at 400 µm, 6.6 - 7.5 mm width Intacs clear curved 150º PMMA segment, 0.40, 0.45mm Intacs position orientated to maximally steep corneal curvature, entrance incision 13 degrees away Single segment inferiorly

Complications Patients counseled re unpredictable refractive result Fluctuating vision, stabilises at 3 months 1 Patient: subincisional Intac migration; repositioned 2 Patients: glare / night vision difficulties No Infection / neovascularisation / melt

Results Variable response, depending on pre-op keratoconic status Mild cones: significant improvement Steep cones, high myopia: less effective Improvement continues over 3 months + If removed: returns to previous keratometry Case example: UCVA = 6/6 UCVA = 6 /20

Results: Refractive Comparison Data Sphere Cylinder SE Preop -0.75Ds -2.85Ds -2.16Ds 3 Months -0.65Ds -1.96Ds * P = 0.015 -1.16Ds * P = 0.008 6 Months -0.30Ds -1.99Ds -1.30Ds * P = 0.018

Results: Keratometry and Symmetry Comparison Data Cylinder Average K’s I-S Ratio Preop 3.14D 46.22D 8.62 6 Months 2.74D 44.49D * P = 0.000 3.32

Results: UCVA

Results: BCVA

Results: Lines of BCVA Gained or Lost at 3 Months

Summary Reversible, adjustable treatment for mild to moderate keratoconus Single inferior Intac placed at maximal corneal steepness determined by topography effective for inferior keratoconus Alternatives: Two Intacs Inserted Intacs SK & Kerarings more effective due to smaller Optical Zone may increase glare Corneal Transplantation if ineffective Adjunctive Cross linking / PRK to enhance effect