Transcript Slide 1

Intacs for the Treatment of
Keratoconus
Ying Qian, MD
Bennie H. Jeng, MD
Cole Eye Institute
Cleveland Clinic Foundation
Cleveland, Ohio
Financial disclosure: none
Introduction
• Intacs (Addition Technology, Inc, Sunnyvale, CA) are
FDA-approved intrastromal corneal ring segments
indicated for the treatment for mild to moderate
keratoconus with clear central corneas
• Indicated in patients with contact lens intolerance
• May delay the need for penetrating keratoplasty
• Flattens the center of the cornea
• Reversible
Purpose
• To evaluate the efficacy of the placement of Intacs
using the manual dissection technique in eyes with
keratoconus
Method
• Retrospective review
• Eleven eyes of 11 patients with keratoconus
• Intacs placement with manual dissection technique
• One surgeon (BHJ)
Results
Patient Pre-op
BSCVa
Post-op
BSCVa
Pre-op
Sph
Equiv
Pre-op
K Cyl
Post-op
Sph
Equiv
Post-op
K Cyl
1
20/60
20/30
-6.25
2.75
-6.25
0.75
2
20/70
20/50
-1.75
6.50
-1.50
3.12
3
20/40
20/25
-4.50
4.88
-7.13
2.63
4
20/40
20/30
-0.50
2.88
+0.75
1.00
5
20/100
20/20
-2.25
4.00
+1.13
3.75
6
20/80
20/60
-3.75
1.50
-4.00
1.25
7
20/200
20/60
-0.75
16.88
+1.25
15.75
8
20/70
20/80
-11.87
8.00
-8.13
3.12
9
20/400
20/30
-5.00
6.38
-0.38
6.00
10
20/30
20/20
-1.50
2.87
+1.50
2.37
11
20/25
20/25
-1.63
1.62
-1.38
2.12
Pre- and Post-Operative Visual Acuity
Number of patients
4
3
pre-op
2
post-op
1
0
20/20
20/25
20/30
20/40
20/50
20/60
20/70
0
0.1
0.18
0.3
0.4
0.48
0.54
20/80 20/100 20/200 20/400
0.6
0.7
1
1.3
Snellen Va
LogMAR
Mean Values
Pre-Op
Post-Op
P value
20/70
20/35
0.016
LogMAR Va
0.55
0.25
0.016
Spherical
Equivalent
-3.61
-2.19
0.053
Keratometric
Cylinder
5.30
3.59
0.011
Snellen Va
(Best spectacle
corrected)
Intacs – Post-Op Day 1 of Patient 1
Corneal Topography of Patient 10
Pre-op
Post-op
Conclusions
• Placement of Intacs using manual dissection technique
appears to be efficacious treatment modality for
keratoconus
• Most patients achieve better spectacle corrected visual
acuity with concurrent decrease in astigmatism