INTACS – PKP Comparison X X 180°-0.75 TransplantIntacs
Current Surgical Options - Keratoconus 10% to 20% of Keratoconus Patients Ultimately Require Surgery Lamellar Keratoplasty Interface haze limits visual result Penetrating Keratoplasty Most frequent procedure – 4,771 cases in 2004 (US) 80-90% successful Issues Graft rejection rate 17.9% Continued astigmatism Endothelial cell loss (limited longevity of graft) Recurrence of Keratoconus
Surgical: Central Endothelial Cell Density Studies Normal: 0.3% - 1.0% Cell loss/Year PRK: 1.6% - 9.0% Cell loss/Year LASIK: 0.1% - 1.0% Cell loss/Year INTACS: 0.2% - 0.5% Cell loss/Year
CORRECTIVE SURGERY: Central Endothelial Cell Density Studies Cataract: 2.5% Cell loss/Year Keratoplasty: 7.8% Cell loss/Year
INTACS - PKP Comparison PKP Irreversible Procedure Time: 1 Hour Rehab Time: Months Intraocular Procedure Lifetime Follow-up Complications Cataract, Glaucoma Endophthalmitis Rejection Expulsive hemorrhage Corneal ulcer Neovascularization Induced astigmatism Disease recurrence Risk of viral transference INTACS Removable Out-Patient Procedure Time: Minutes Rehab Time: 1-2 Weeks (Visual Function Immediate) Corneal Lamellar Procedure Periodic Follow-up Complications Unsatisfactory ring placement Segment extrusion Infection (Easily managed with segment removal)
INTACS - PKP Comparison PKP Significant loss of endothelial cells Permanently weakened cornea with risk of additional trauma Outcomes: unpredictable, often unstable INTACS Endothelial cell loss, not clinically significant 1 Provides structural integrity, PKP still an option without complication Outcomes: predictable, case dependent 1 Two-Tear Endothelial Cell Assessment following INTACS implantation, Azaretal, J Refract Surg Sept-Oct
Conclusions: INTACS Intervention Superior to Transplant INTACS restore functional vision Functional refraction with soft, soft-toric, or rigid contact lenses is likely Creates cornea more receptive to contact lenses INTACS reduce corneal coning Central cone is flattened Asymmetrical cones are repositioned centrally INTACS post-surgical recovery Visual improvement can be immediate Vision stabilizes in months rather than a year or longer High potential to defer transplant