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Corneal Intacs

AC

Andrew Choi

Transcript

Corneal Intacs

53yo HM (EM)

  • 6/10/2022 "NP" CEE (7/2017)
  • Oc Hx: KCN (>20yrs)
  • Oc Sx: Intacs (OS) - 2006
  • MHx: Cholesterol (Atorvastatin), HTN (Losartan)
  • FHx: None

Pt Info

Exam Data

Exam Data

CC: None, "Just want an extra pair of glasses"

VA: OD (20/25+2), OS (20/100+1, PH 20/80)

Habitual Rx: OD -6.50-3.00x030 ADD +1.00

OS -8.50-3.00x120 ADD +1.00

Entrance Testing: WNL

Cornea: OD/OS (Vogt's Striae), OS (Stromal Scar - Centrally)

Posterior Segment: Unremarkable

Refractive Plan

Refraction:

OD: -7.50-1.50x180 ADD +2.25 (VA 20/25)

OS: -10.00-3.00x140 ADD +2.25 (VA 20/80)

Not interested in specialty CL to improve BCVA in OS

Monovision (incorporated ADD into OS distance Rx):

OD: -7.50-1.50x180 (DVA 20/25), OS: -7.50-3.00x140 (NVA 20/25)

Intacs (3,9)

Intacs

ICRS

Intrastromal Corneal Ring Segments (ICRS)

  • FDA approved 2004 (originally designed for low levels of myopia)
  • Mild to Moderate Keratoconus
  • Option for pt's who can no longer see adequately with glasses or CL alone
  • Possible alternative for pt's requiring a corneal transplant
  • Clear, crescent shaped device made of plastic polymer
  • Reshape the cornea by thickening the periphery to flatten the center into a more dome-like shape, can also reposition the cone centrally
  • Round cross section helps to minimize glare

Topography

Clinical Info

  • Typically gain >/= 2 lines BCVA
  • Still need correction through Spectacles, Specialty CL
  • Designed for permanent placement, can be removed or replaced if necessary
  • Possible slowing of progression
  • Recommendations: >/= 21yo, Clear Central Corneas, Corneal Thickness 450um (incision site)
  • Contraindications: Collagen Vascular/Autoimmune Disease, Pregnant/Nursing, RCE/Corneal dystrophy

Clinical Pearls

  • Complications: Infection, Difficulty with night vision
  • Check for NV, Edema, Scarring

  • Usefulness of Monovision

  • Incorporation of ICRS as a possible treatment option for KCN

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