An unusual complication of Intacs implantation
Superior migration of one segment and fibrovascular ingrowth required explantation.
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We report an unusual complication in a case of Intacs (KeraVision) implantation.
A 35-year-old white male underwent a bilateral Intacs procedure for correction of –1.25 sphere OD and –2.25 sphere OS.
In the right eye, 0.25-mm Intacs segments were used. Placement and postoperative course and acuity were unremarkable.
Surgical placement of the 0.35-mm Intacs segments in the left eye proceeded uneventfully with the caveat that the temporal segment was left in a slightly superior (+1) position.
No sutures were used in either eye.
Vision was 20/15 uncorrected OD and 20/20+ uncorrected OS.
At the 2-week postoperative visit the temporal ring was noted to have migrated to a position just beneath the incision site. As we have noted this occurrence in previous cases with Intacs, we took no action.
Subsequently, a fibrovascular membrane was noted growing into the tunnel of the offending Intacs segment. This was followed by the development of a similar membrane into the track of the properly placed nasal Intacs segment. Both membranes grew rapidly. Explantation was carried out. At the time of explantation, profuse bleeding occurred into both Intacs tunnels, completely filling them with blood.
Over the ensuing month, the blood absorbed completely without intervention. A small amount of haze remained in the tracks. Refraction, keratometry readings and corneal topography returned to their preoperative levels.
Three months later a LASIK procedure was performed uneventfully, with a resulting visual acuity of 20/20.
No sight-threatening complications
To date the authors have performed approximately 250 Intacs procedures, with a follow-up extending to 18 months.
We have experienced no sight-threatening complications. The most frequent complication (data to be published) is the development of induced astigmatism against the rule, which often responds to correction by suture placement in the wound.
The case presented above reinforces the concept of proper ring placement away from the wound site. We believe that this complication could have been avoided in the operating room when the superior placement was initially noted. Correction may also have been possible at the first appearance of the superior migration of the Intacs segment.
The vast majority of complications associated with Intacs surgery are remedied without great difficulty.
For Your Information:
- George Peyton Neatrour, MD, is founder of Beach Eye Care Center for Vision Correction in Virginia Beach, Va., where Douglas M. Rampona, MD, is an associate surgeon. They can be reached at 840 First Colonial Road, Suite 103, Virginia Beach VA 23451; (757) 425-5550; fax: (757) 496-2457; e-mail: bec@exis.net. Dr. Rampona has no direct financial interest in the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- KeraVision Inc., manufacturer of Intacs micro-thin prescription inserts, can be reached at 48360 Milmont Dr., Fremont, CA 94538; (510) 353-3000; fax: (510) 353-3030.