|Articles|May 1, 2015

Intrastromal rings for keratoconus

Take-home message: Implantation of intrastromal rings for keratoconus can be a highly effective treatment with proper patient screening, surgical planning, and femtosecond laser precision.

Take-home message: Implantation of intrastromal rings for keratoconus can be a highly effective treatment with proper patient screening, surgical planning, and femtosecond laser precision.

By Martin J. Fox, MD, FACS; Special to Ophthalmology Times

Though patients with fully expressed keratoconus often require keratoplasty as the only viable option for visual rehabilitation, precision implantation of intrastromal corneal rings (Intacs, Addition Technology/Oasis) may be offered to carefully selected candidates.

The degenerative disease is characterized by a progressive thinning of the cornea leading to loss of structural integrity and shape distortion. Current estimates suggest that the disease has an incidence of 1 in 2,000.

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For those in the field of refractive surgery, however, this figure seems low. Patients are constantly being identified with subclinical forms of the disease that may have escaped detection.

The disease typically presents in adolescence and can progress through the fourth decade of life-producing visual distortion uncorrectable with spectacles and often associated with contact lens intolerance.

With carefully selected candidates, proper surgical planning, and precision implantation of intrastromal rings, patients can be offered a viable treatment option with potential to restore “walking around” functional vision, spectacle-corrected acuity, and contact lens tolerance.

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These rings are placed at 75% depth in the cornea making use of femtosecond laser (Intralase, Abbott Medical Optics) channel creation.

When properly placed, the rings can reshape and regularize corneal morphology-creating very satisfactory clinical outcomes. The femtosecond laser/rings procedure deserves consideration by all corneal surgeons before consideration of corneal transplant and its inherent issues.

Frequently dismissed by the ophthalmic community over prevailing concerns regarding consistency and efficacy in outcomes, surgeons can now anticipate excellent intrastromal ring outcomes via careful patient selection, appropriate surgical planning, and the use of femtosecond laser precision.

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