Comparison of single-segment and double-segment Intacs® insertion with femtosecond laser for keratoconus Tiep KHUC, Marc DOAT, Jean-Louis BOURGES, Nicolas.

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Presentation transcript:

Comparison of single-segment and double-segment Intacs® insertion with femtosecond laser for keratoconus Tiep KHUC, Marc DOAT, Jean-Louis BOURGES, Nicolas ALFONSI, Jean-Marc LEGEAIS, Gilles RENARD Hôtel-Dieu Hospital, Paris, France Authors have no financial interest

Purpose To evaluate the efficacy of single-segment Intacs® using the femtosecond laser (IntraLase®, AMO) for insertion and compare with double-segment Intacs® in subjects with keratoconus

Methods (1/2) Setting: Hôtel-Dieu, Paris, France Prospective study 66 eyes of 59 patients classified into two groups - single-segment group: 38 eyes, 35 patients - double-segment group: 28 eyes, 26 patients Both groups matched by t test

Methods (2/2) Implantation procedure Femtosecond IntraLase ® FS 2 laser (60 kHz) (IntraLase Corp.) Parameters - dissection’s depth in the cornea was 80% of the central pachymetry (300 – 400 µ) - channel dissection size: 6.6 x 7.6 mm Main outcome measure: improvement of visual acuity, refractive error, K values Follow-up: 6 months Single or double-segment Intacs® implanted according to keratoconus asymetry and spherical equivalent (SE)

Global results VariablePreoperativePostoperative UCVA (logMAR)1.13±0.46 (0.5/10)0.57±0.45 (3/10) BSCVA (logMAR)0.54±0.33 (3/10)0.34±0.30 (5/10) Sphere (D)-3.37± ±2.76 Cylinder (D)-3.90± ±1.80 SE (D)-5.41± ±2.99 Steep K (D)57.4± ±6.9 Flat K (D)46.4± ±5.0 Average K (D)51.9± ±5.5 p < 0.05 for each variable.

Single-segment results VariablePreoperativePostoperative UCVA (logMAR)1.01±0.49 (1/10)0.40±0.34 (4/10) BSCVA (logMAR)0.45±0.31 (4/10)0.24±0.22 (6/10) Sphere (D)-2.53± ±2.56 Cylinder (D)-4.14± ±2.47 SE (D)-4.59± ±2.80 Steep K (D)56.1± ±6.0 Flat K (D)43.7± ±3.5 Average K (D)49.9± ±4.2 p < 0.05 for each variable. Improvement of UCVA for 34 eyes (89%).

Double-segment results VariablePreoperativePostoperative UCVA (logMAR)1.32±0.32 (0.5/10)0.82±0.48 (1.6/10) BSCVA (logMAR)0.69±0.32 (2/10)0.49±0.34 (3/10) Sphere (D)-4.95± ±3.16 Cylinder (D)-3.44± ±1.70 SE (D)-7.13± ±3.33 Steep K (D)59.6± ±7.8 Flat K (D)50.4± ±6.9 Average K (D)55.0± ±7.0 p < 0.05 for each variable, except cylinder (p=0.18). Improvement of UCVA for 21 eyes (75%).

Comparison double vs single- segment Only 1 eye experienced loss of BSCVA in the single-segment group, versus 5 eyes in the double-segment group.

Complications No peroperative complication 8 Intacs® (7.6%) were removed from 5 eyes because of partial extrusion

Discussion (1/2) Safe and efficient; improvement of UCVA+++ Trend towards improved outcomes with single- segment Intacs® (more important reshaping of the cornea) Results consistent with existent data (Sharma, 2005) Cases of loss of vision may be attributed to an induced irregular astigmatism

Discussion (2/2) Double- segment (preop/postop/ differential) Single- segment (preop/postop/ differential) Superior and inferior flattening Superior steepening Inferior flattening

Conclusion Intacs® implantation using IntraLase® FS 2 was safe and effective for treating keratoconus Better results were achieved with single-segment Intacs® Colin J, Cochener B, Savary G, Malet F, Holmes-Higgin D. INTACS inserts for treating keratoconus: one-year results. Ophthalmology 2001;108: Siganos CS, Kymionis GD, Kartakis N, Theodorakis MA, Astyrakakis N, Pallikaris IG. Management of keratoconus with Intacs. Am J Ophthalmol 2003;135: Alio JL, Artola A, Hassanein A, Haroun H, Galal A. One or 2 Intacs segments for the correction of keratoconus. J Cataract Refract Surg 2005;31: Sharma M, Boxer Wachler BS. Comparison of single-segment and double-segment Intacs for keratoconus and post-LASIK ectasia. Am J Ophthalmol 2006;141: Ertan A, Kamburoglu G. Intacs implantation using a femtosecond laser for management of keratoconus: Comparison of 306 cases in different stages. J Cataract Refract Surg 2008;34: