Refractive and Topographic Results of Transepithelial Cross-Linking Treatment in Eyes With Intacs

Abstract

Intacs implantation with transepithelial CXL is effective in eyes with keratoconus. Collagen cross-linking has an additive effect on Intacs implantation in these eyes and may be considered as an enhancement/stabilizing procedure.

New clinical pathways for keratoconus

“…In a case series of Intacs ICRS with 3-year follow-up in 13 eyes, significant increases in average K values were observed between 6 months and 3 years, indicating that disease stabilisation was not achieved by ICRS alone. 51 Combined ICRS and CXL ICRS implantation can be combined with CXL, [52][53][54][55][56] but the treatment sequence is important: ICRS appears more effective in improving corneal shape before the cornea is stiffened with CXL. Coskunseven et al, 52 in an RCT comparing CXL first and ICRS later (group 1) with ICRS first and later CXL (group 2), showed significantly greater improvements (mean 7 months follow-up) in spectacle CDVA (three line gain (group 1); two line gain (group 2), Po0.01) and manifest astigmatism (2.48D mean absolute cylinder reduction (group 1); 1.76D reduction (group 2), Po0.05) where ICRS was performed first.…”

“…[43][44][45][46][52][53][54][55][56] We would therefore argue for gross shape correction with ICRS implantation followed by CXL, fine shape correction with PRK if necessary, then finally pIOL implantation as a logical pathway to visual rehabilitation in grade II-III keratoconus (Figure 4). …”

Depth evaluation of intended vs actual intacs intrastromal ring segments using optical coherence tomography

“…8 Ferrara rings are hence implanted closer to the centre of the cornea and presumably have a stronger flattening effect. 10 Intacs SK are a new segment design by Addition Technology, intended for the treatment of moderate to severe keratoconus. They are 6 mm oval-shaped segments, available in 400 and 450 μm thicknesses.…”

Corneal Cross-linking in Combination with Intracorneal Ring Segments

“…Additionally, the mid corneal layers continue to evolve and thicken over the time, which in turn may contribute to the biomechanical effects of Intacs. In the work by Ertan et al, 9 the synergistic effect of CXL performed on average 3.98 +/-5.7 months after ICRS implantation might be explained in part by the continuing effect of ICRS-related corneal remodeling. Combining both procedures in the same day is attractive for the patients and surgeons, reducing the time and cost of treatments, and probably minimizing the infectious risks.…”