title: Combined ICRS insertion and LASIK to maximize postoperative residual bed thickness in high myopia.
abstract: OBJECTIVE
  To describe a new technique and early outcomes of combined intrastromal corneal ring segment (ICRS) insertion and laser in situ keratomileusis (LASIK) to treat patients with moderate to high myopia and thin corneas.
  
  
  METHODS
  University-based academic practice, Boston, Massachusetts, USA.
  
  
  METHODS
  Combined ICRS insertion and LASIK was performed in 2 stages: ICRS channel formation (stage I) followed by LASIK and ICRS insertion (stage II).
  
  
  RESULTS
  Fifteen eyes of 11 patients with a mean preoperative spherical equivalent of -9.98 diopters (D) +/- 2.60 (SD) (range -7.13 to -16.25 D) and mean preoperative astigmatism of 1.11 +/- 0.75 D (range 0.00 to -3.00 D) were treated with combined ICRS insertion and LASIK. The mean central pachymetry was 526.13 +/- 35.69 microm (472 to 579 microm). The uncorrected visual acuity was 20/40 or better in 7 of 15 eyes (46.67%) at 1 month, 6 of 12 eyes (50.00%) at 3 months, 5 of 12 eyes (41.67%) at 6 months, and 6 of 12 eyes (50.00%) at 12 months. The best spectacle-corrected visual acuity was 20/40 or better at all times. Postoperative maps confirmed the absence of ectasia. The postoperative spherical equivalent was within +/-1.00 D of the intended refraction in 11 of 15 eyes (73.33%) at 1 month, 9 of 12 eyes at 3 and 6 months, and 8 of 12 eyes (66.67%) at 12 months.
  
  
  CONCLUSIONS
  Results of combined ICRS insertion and LASIK in moderately to highly myopic patients with relatively thin corneas were good. Long-term studies are needed to determine whether this procedure will decrease the risk of LASIK-induced keratectasia in these patients.
authors.affiliation: Corneal and Refractive Surgery Services, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
authors.forename: Shahzad I
authors.initials: SI
authors.lastname: Mian
authors.forename: Elias F
authors.initials: EF
authors.lastname: Jarade
authors.forename: Amy
authors.initials: A
authors.lastname: Scally
authors.forename: Dimitri T
authors.initials: DT
authors.lastname: Azar
mesh_terms: D000328:Adult; D003316:Corneal Diseases / Q000517:prevention & control; D003319:Corneal Stroma / Q000473:pathology / Q000601:surgery*; D019781:Corneal Topography; D004108:Dilatation, Pathologic / Q000517:prevention & control; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000601:surgery*; D011182:Postoperative Care; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods*; D012449:Safety; D016896:Treatment Outcome; D014792:Visual Acuity