1. post-lasik corneal ectasia
Femtosecond laser assisted intrastromal corneal ring segment implantation for
post-lasik corneal ectasia
Dominique PIETRINI, MD
Tony GUEDJ,OD,ORTH
Clinique de la Vision, Paris.
 Financial disclosure: Dr D. Pietrini is a paid consultant for Mediphacos 1

2. Materials and Methods
13 eyes with post lasik ectasia, follow up 6 months to 4 years.
Mean age 38 years
Initial surgery
Microkeratome 80% Femtosecond 20%
Time between lasik ands ICRS 3 years
Form frust keratoconus in 8 cases / Insufficient stromal bed 2 cases / unkown etiology or association remaining cases
ICRS femtosecond implantation all cases
3 eyes implanted with Intacs (Addition technology)
10 eyes implanted with Kerarings (Mediphacos)
Interest of OCT for corneal evaluation
Mean flap thickness 148µm +/- 16.5µm (120/200)
Mean residual stromal bed 294µm +/- 55.1µm (210/400)

3. Evolution of spherical equivalent and refractive cylinder

4. Evolution of uncorrected and best corrected visual acuity
UCVA
Mean gain 5 lines
BCVA
Mean gain 3 lines
p<0.05
N=13

5. Keratometric measurements Orbscan readings
Keratometry
Mean K
reduced by 3D
Kmax
reduced by 4.6D
p<0.05
N=13

6. Corneal astigmatism
N=13

7. High Order Aberration N=2
HOA Rms showed a reduction of 59% after 2years for Two eyes
Vertical Coma showed a reduction of 69% after 2years for Two Eyes
H.Coma
N=2

8. Case Report M. A.B,Man, 33 years old Post lasik ectasia:
Marginal pellucid corneal dystrophy
LEFT EYE
PRE OP
1 Week after
KERARING
IMPLANTATION
KERATOMETRY:
38.4D /43.7D 3°
38.2D/40.9D 175°
ASTIGMATISM:
5.3D
2.7D
PACHYMETRY:
401µm
414µm
UCVA:
0.5 Log mar (3/10)
0.0 Log mar (9/10)
BCVA:
0.0 Log mar (10/10F)
-0.1 Log mar (12/10)
REFRACTION:
+1,75 (-4,50)85°
+2.50 (-2.50)85°

9. Post lasik ectasia on marginal pellucid corneal dystrophy
OCT Visante
Corneal Flap
OCT PRE OP :
Size of corneal flap
Post lasik ectasia on marginal pellucid corneal dystrophy
Corneal Flap
KERARING
OCT POST OP KERARING:
Depth: 310µm
Corneal Flap: 120µm

10. Marginal pellucid corneal dystrophy POST LASIK ECTASIA POST KERARING
Orbscan Dual
POST LASIK ECTASIA :
Marginal pellucid corneal dystrophy
Corneal Flap
OCT PRE OP
POST LASIK ECTASIA
Corneal Flap
PRE OP
REFRACTION: +1,75 (-4,50)85°
UCVA:0.5 Log mar
BCVA:0.0 Log mar
POST OP 1 Week
REFRACTION: (-2.50)85°
UCVA :0.0 Log mar
BCVA:-0.1 Log mar
KERARING
OCT POST OP
POST LASIK ECTASIA POST KERARING
DEPTH: 330µm
Corneal Flap: 120µm

11. CONCLUSION
Femtosecond intrastromal corneal ring segment implantation is an affective and safe method for the management of post lasik ectasia.
Restores good level of visual acuity.
Objective improvement of visual acuity.
BCVA improved by 3 lines.
Corneal astigmatism reduced by 2,6 d.
Maximal keratometry reduced by 4.6 diopters.
Reduce Hoa Rms.
High patient satisfaction.
Low complications rate.
Reversible.

12. Dominique Pietrini, MD, is a member of
the active staff of the Clinique de la Vision,
Paris France.
Dr. Dominique Pietrini states that he is a paid consultant
to Mediphacos.
Dr. Pietrini can be
reached at
.com

13. Tony Guedj, OD,ORT
Clinique de la vision,
Paris France.
Tony Guedj can be
reached at