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Single Inferior Intac Insertion for Inferior Keratoconus

Single Inferior Intac Insertion for Inferior Keratoconus. James Genge MD Vision Eye Institute Southline Sydney Australia. No Financial Interest to disclose. Purpose. To investigate the effectiveness of a single inferior Intac segment for inferior keratoconus

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Single Inferior Intac Insertion for Inferior Keratoconus

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  1. Single Inferior Intac Insertion for Inferior Keratoconus James Genge MD Vision Eye Institute Southline Sydney Australia No Financial Interest to disclose

  2. Purpose • To investigate the effectiveness of a single inferior Intac segment for inferior keratoconus • Rationale was to harness the flattening effect of the Intac segment by placement in the area of maximal steepness noted on corneal topography • Entrance incision positioned to allow adequate distance from Intac segment to minimise extrusion risk.

  3. Study • Demographics • N = 46 • Average age 35 • 65% Male 35% Female • 0.45mm Intac 76% • 0.40mm Intac 24% • Indications • K’s < 55 • No central scarring • Inferior corneal thickness > 430 • Post op follow up for 6 months assessing: • UCVA • BSCA • Change in keratometry • Change in Inferior: Superior ratio index • Complications } Asymmetry > 4 D, select 0.45mm segment

  4. Method • Corneal center marked • Intralase created channel at 400 µm, 6.6 - 7.5 mm width • Intacs clear curved 150º PMMA segment, 0.40, 0.45mm • Intacs position orientated to maximally steep corneal curvature, entrance incision 13 degrees away • Single segment inferiorly

  5. Complications • Patients counseled re unpredictable refractive result • Fluctuating vision, stabilises at 3 months • 1 Patient: subincisional Intac migration; repositioned • 2 Patients: glare / night vision difficulties • No Infection / neovascularisation / melt

  6. Results • Variable response, depending on pre-op keratoconic status • Mild cones: significant improvement • Steep cones, high myopia: less effective • Improvement continues over 3 months + • If removed: returns to previous keratometry Case example: UCVA = 6/6 UCVA = 6 /20

  7. Results: Refractive Comparison Data

  8. Results: Keratometry and Symmetry Comparison Data

  9. Results: UCVA

  10. Results: BCVA

  11. Results: Lines of BCVA Gained or Lost at 3 Months

  12. Summary • Reversible, adjustable treatment for mild to moderate keratoconus • Single inferior Intac placed at maximal corneal steepness determined by topography effective for inferior keratoconus • Alternatives: • Two Intacs Inserted • Intacs SK & Kerarings • more effective due to smaller Optical Zone • may increase glare • Corneal Transplantation if ineffective • Adjunctive Cross linking / PRK to enhance effect

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