EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/618732
51 EW CORNEA January 2016 Contact information Jackson: mjlaserdoc@msn.com Kilic: aylinkilicdr@gmail.com Perez: mauricioperezvelasquez@gmail.com Trattler: wmtrattler@gmail.com it's available, I'll do both epi-on CXL and Intacs simultaneously so patients only have to go through one procedure." Dr. Perez also agreed the main goal of ICRS is "to improve uncor- rected visual acuity and contact lens tolerance. On the other hand, the main goal with CXL is to alter disease progression by strengthen- ing the cornea" so he thinks these are two synergistic—but not inter- changeable—procedures. "There is a certain biomechan- ical effect with ICRS that could modify disease progression, and there is also a certain flattening effect with CXL that could help in terms of uncorrected visual acuity, but those are not their main objec- tives nor indications while deciding the treatment algorithm. ICRS and CXL are treatment options that will complement each other and are not meant to replace each other." Dr. Kilic maintains ICRS can provide good outcomes, but notes CXL and rings together have the added advantage of helping main- tain stability. What Intacs and Intacs SK cannot do If the keratoconic patient has devel- oped scarring, "you're likely to have reduced distance/near corrected visual acuity and may find the cor- nea too thin for CXL or Intacs," Dr. Jackson said. "When I see scarring, I immediately start thinking kerato- plasty if a contact lens does not give the patient adequate vision to func- tion." For these patients, functional vision is determined individually based on a patient's occupational and recreational needs. Dr. Kilic limits the implantation area in cases of severe corneal scar- ring to a minimal 450 microns. "In these cases, however, I typically do not recommend ICRS. I prefer keratoplasty for those pa- tients," she said. Finally, there remains the challenge that, long term, "patients with keratoconus can still progress despite having Intacs, so CXL is an important consideration for patients who have received Intacs for kerato- conus," Dr. Trattler said. EW References 1. Sharma M, et al. Comparison of single- segment and double-segment Intacs for keratoconus and post-LASIK ectasia. Am J Ophthalmol 2006;141:891–895. 2. Yeung SN, et al. Efficacy of single or paired intrastromal corneal ring segment implan- tation combined with collagen crosslinking in keratoconus. J Cataract Refract Surg. 2013;39:1146–1151. Editors' note: The physicians have no financial interests related to this article.