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Published on: November 12, 2015
Long-term follow-up of Intacs for post-LASIK corneal ectasia
George D Kymionis1, Nikolaos S Tsiklis, Aristofanis I Pallikaris
1Department of Ophthalmology, Institute of Vision and Optics, University of Crete, Medical School, Crete, Greece. kymionis@med.uoc.gr
Objective:
To report long-term follow-up of Intacs microthin prescription inserts for the management of post-LASIK corneal ectasia.
Design:
Long-term (5 years), retrospective, nonrandomized study.
Participants:
Eight eyes of 5 patients with post-LASIK corneal ectasia (3 men and 2 women) ages 31 to 54 years (mean age+/-standard deviation [SD], 41.60+/-9.24 years) who had completed 5 years of follow-up (mean follow-up +/- SD, 60.1+/-4.9 months; range, 57-68 months).
Intervention:
Two Intacs segments, inserted in the usual fashion, were used for low myopia correction (1 each nasally and temporally), with thickness based on the residual refraction of the patients.
Main Outcome Measures:
Manifest refraction, uncorrected and best spectacle-corrected visual acuity, patient satisfaction, topography, and confocal microscopy analysis.
Results:
No intraoperative or late postoperative complications occurred in this series of patients. At 5 years, the SE error was statistically significantly reduced (pre-Intacs mean+/-SD, -5.47+/-2.66 diopters [D]; range, -11.50 to -3.00 D) to -2.56+/-3.44 D (range, -9.50 to 1.5 D; P = 0.01). At the end of the first postoperative year, refractive stability was obtained and remained stable during the follow-up period with no significant changes between the interval meantime (P>0.05). Pre-Intacs uncorrected visual acuity was 20/100 or worse in all eyes (range, counting fingers-20/100), whereas at the last follow-up examination, 6 (75%) of 8 eyes had uncorrected visual acuity of 20/40 or better (range, counting fingers-20/25). Two eyes (25%) maintained the pre-Intacs best spectacle-corrected visual acuity, whereas the rest of the eyes (6 eyes; 75%) experienced a gain of 1 or 2 lines. At the end of the first postoperative year, uncorrected and best-spectacle corrected visual acuity and topographic stability were obtained and were shown to have remained stable during the follow-up period with no significant changes between the interval meantime. Lamellar channel deposits were observed in confocal microscopy at or adjacent to the intrastromal ring segment.
Conclusions:
Refractive stability was maintained for up to 5 years in the treatment of post-LASIK corneal ectasia after Intacs implantation. There was no evidence of progressive time-dependent corneal ectasia, late regression, or sight-threatening complications in this study.
