Case Reports

Unusual reposition of Intacs extrusion in stable post LASIK ectasia patient

Case Report Details

First Author: S.Sella ISRAEL

Co Author(s):    S. Sella   S. Melki                 

Abstract Details

Purpose:

To describe our experience of unusual reposition on intacs in post LASIK ectasia patient

Setting:

Boston eye group doctors, Boston, MA, USA

Report of Case:

A 32-year-old patient with a history of non-progressive Post-LASIK ectasia in his both eyes presented to us with right eye lower Intacs extrusion. His Best-corrected visual acuity of 20/40, with glasses prescription of right eye -0.75/-3.50X55 and his left eye-0.5/-4X155 with previous best-corrected 20/20 20/25. His topography (Figure 1a right eye, figure 1b) with typical features of the ectatic cornea with pachymetry of 454 microns. His symptoms were foreign body sensation and irritation. His examination of right eye cornea (Figure 2a) shows lower intact with nasal side extruded from the tunnel. Per patient, the tunnel created without the femtosecond technique. We planned for intracorneal rings segment repositioning in the right eye. In the meantime, due to international logistics restrictions, the patient treated with moxifloxacin eye drops four times a day for one week. His ocular history included LASIK procedure about eight years ago. Due to developing ectasia, he was treated with crosslinking in both eyes three years after the initial procedure. The intrastromal corneal ring implanted two years after last cross linking; the right eye with lower intacs and left eye with superior and inferior intacs (Figure 2b). Intraoperatively the rings were repositioned with the help of Sinskey hooks to the corneal tunnel. We were partially cutting the extruded intact. After securing the intacs into the tunnel we glued the entrance. The decision regarding gluing the tunnel was based on suspected thinning and impending the melting of the edge of the tunnel (Figure 2a,b,c). The patient left home with a bandage contact lens, and Gatifloxacin and dexamethasone drop four times a day. After two days, the patient's BCVA was 20/25 without symptoms (Figure 3). One month follow up his condition stable and the patient was happy with vision and results, we maintained CL for better protection and healing.

Conclusion/Take Home Message:

Reposition of the malpositioned intrastromal ring without sutures and or removal is safe and effective in preserving the refractive condition.

Financial Disclosure:

None