Simultaneous wavefront-guided PRK and CXL for keratoconus after ICRS implantation was safe and effective. It significantly improved the UDVA, CDVA, and central K value, and consequently the visual function, of patients with moderate keratoconus.

To describe the visual outcome of keratoconus managed with Intacs implantation (Addition Technology Inc, Fremont, Calif) and to define criteria that predict good outcome.Methods: This retrospective, nonrandomized, comparative, consecutive case series studied 58 eyes of 43 patients with keratoconus managed by Intacs implantation. The outcome measures were analyzed pre-Intacs and 1 year post-Intacs. Preoperative parameters were correlated with outcome.Main Outcome Measures: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, videokeratography, and patient questionnaires.Results: Intacs were implanted in all eyes with no in-traoperative complications. Six eyes underwent additional Intacs surgery. Post-Intacs, the mean±SD UCVA improved from less than 20/200 ± 0.1 line to 20/ 50 −3 ±3.1 lines, the mean±SD BSCVA was unchanged at 20/32±2.0 lines, the mean±SD spherical equivalent improved from −3.88±1.64 to −1.04±1.51 diopters (D), and the mean±SD astigmatism improved from 3.34±2.23 to 1.97 ± 1.51 D. Twenty-five eyes had a good outcome (UCVAՆ20/40). Multiple regression selected BSCVA, astigmatism, and spherical myopia as the preoperative predictors of outcome.Conclusions: Intacs improve myopia and regular astigmatism in keratoconus. Milder keratoconus (BSCVAϾ20/ 32 −2 and astigmatismϽ3.50 D) and significant spherical myopia (Ͼ−1.75) predict better outcome.

Implantation of a single Intacs segment inferiorly appeared to improve progressive myopia and regular and irregular astigmatism in eyes with corneal ectasia after LASIK. With further study, this technique may prove to be an effective, relatively noninvasive approach.

Any viscoelastic material may be contaminated by heat-stable bacterial endotoxic as it is prepared by gene-coded bacteria. It is suggested that Multivisc BD was the etiologic factor of TASS. Refractive surgeons should be aware of this rare complication of phakic IOL implantation whenever they use a new viscoelastic material.

Monovision excimer laser correction provides both effective and satisfactory results and should be considered as an option for individuals with myopic presbyopia suitable for, and interested in, refractive surgery.