Treatment of advanced keratoconus with INTACS SK intrastromal corneal ring segment: 5 year outcomes

Session Details

Session Title: Cornea Surgical II

Session Date/Time: Tuesday 13/09/2016 | 08:00-10:30

Paper Time: 08:06

Venue: Hall C2

First Author: : J.Court UK

Co Author(s): :    M. Muhtaseb                    

Abstract Details

Purpose:

To report the long-term efficacy, stability and safety of INTACS SK intrastromal corneal ring segments (ICRS) to manage advanced keratoconus, where regular INTACS are likely to have limited results, as a strategy for delaying the need for keratoplasty. 5 year follow-up data are presented.

Setting:

Singleton Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, United Kingdom

Methods:

INTACS SK ICRS were manually implanted in 34 eyes of 30 patients with moderate to advanced keratoconus (defined as mean keratometry (K) >53.0 dioptres (D), or keratometric astigmatism >4D with a mean K of 49.0-53.0D). Outcome measures included uncorrected (UDVA) and corrected distance visual acuity (CDVA), contact lens (CL) tolerance, 'real-life' visual acuity (RDVA) (uncorrected, spectacle or CL corrected acuity as worn by the patient day to day), extrusion rates and late complications. Length of follow-up was 5 years post-implantation.

Results:

Mean UDVA, CDVA and RDVA were improved 5 years post-operatively (0.99LogMAR, 0.41LogMAR and 0.58LogMAR respectively) versus pre-operatively (1.38LogMAR, 1.03LogMAR and 1.24LogMAR) (p<0.01). 19% regularly wore CL at 5 years, with 75% identifying preference and good spectacle CDVA as the main reason for not using CL, rather than poor tolerance. No statistically significant difference was found in UDVA, CDVA or RDVA between 1 and 5 years (p= 0.47, 0.69 and 0.89), showing stability. Early extrusion (<6 months) occurred in 14.7%. 2 patients required late removal for vascularisation, and 1 for extrusion complicated by infection. Atopy was a risk factor for extrusion.

Conclusions:

ICRS implantation achieved beneficial results in advanced keratoconus, with stability over 5 years of follow-up. Regularisation of the cornea improved both spectacle CDVA and CL tolerance. A slightly higher extrusion rate was seen in atopic patients and in more advanced keratoconus with steeper Ks than in some previous reports.

Financial Disclosure:

NONE