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One Intacs segment sufficient to manage keratoconus, surgeon says
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WASHINGTON – Using a single intrastromal corneal ring segment instead of the standard two to manage keratoconus gives patients less glare and “dramatic” improvement in best-corrected visual acuity, said Antonio Marinho, MD.
Dr. Marinho said he began inserting only one segment of Intacs (Addition Technology) instead of the standard two segments in 2003 for patients with keratoconus. He said he makes a temporal incision and inserts the Intacs segment in the inferior cornea, the steepest part of the cone.
“We think that using the thickest ring in all cases upon the steepest part of the cornea will have the greatest effect without the need of the second ring,” he said.
If the patient’s upper cornea is steep as well Dr. Marinho will insert a second ring, he said.
In 15 eyes of 12 patients who were followed from 3 to 24 months, best corrected visual acuity remained the same or improved by up to seven lines in all patients.
“Most showed a five-line-or-more gain,” Dr. Marinho said here at the American Society of Cataract and Refractive Surgery meeting.
As with other published studies of Intacs for keratoconus, Dr. Marinho said, he noted no correlation between corneal curvature changes and postop refraction or BCVA.
“Trying to do a nomogram in patients with keratoconus is of no use,” he said.
In his study, he used the 0.45-mm-diameter Intacs in every patient, yet got vastly different refractive results, he said. Because Intacs is designed for centration on the cornea, he said, he believes its use in keratoconus can be associated with poor refractive results.
Nine of 15 eyes in the study had “very good” centration, which explained the excellent results for those patients, he said.