Intacs adjustment surgery for keratoconus.
OBJECTIVE
To describe the visual outcome of keratoconic eyes managed with Intacs (Addition Technology, Inc.) that required additional Intacs surgery (defined as any combination of removal, exchange, addition, or shifting of an Intacs segment).


METHODS
Private refractive surgery center, Jerusalem, Israel.


METHODS
This retrospective noncomparative interventional consecutive small case series studied all eyes of a cohort of 58 keratoconic eyes managed with Intacs that had additional Intacs surgery. The uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity, manifest refraction, videokeratography, and patient questionnaires on visual function were assessed. These outcome measures were compared before Intacs implantation, before Intacs adjustment, and 1 year after the final Intacs adjustment. Eyes having any intervention other than Intacs surgery were excluded.


RESULTS
Of 58 keratoconic eyes managed with Intacs, 7 had additional Intacs surgery. After the initial Intacs surgery, 6 of these eyes had UCVA < or =20/100 and 1 had UCVA of 20/50. After the final Intacs adjustment, 3 eyes achieved UCVA > or =20/40, 5 achieved UCVA > or =20/70, and 2 remained <20/200. The indications for Intacs adjustments were increased astigmatism in 4 eyes, induced hyperopia (overcorrection) in 3, and undercorrection in 1. One eye had both surgically induced astigmatism and hyperopia. Induced astigmatism and hyperopia were most often managed by removing the superior segment. The undercorrected eye, having initially received a single inferior segment, was treated by implanting a superior segment.


CONCLUSIONS
Approximately 10% of keratoconic eyes managed with Intacs may require Intacs adjustment surgery, which often has a good outcome.
Pokroy
Russell
R
Enaim Refractive Surgery Center, Jerusalem, Israel. pokroyr@yahoo.com
Levinger
Samuel
S
D000328:Adult; D001251:Astigmatism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D003319:Corneal Stroma / Q000503:physiopathology / Q000601:surgery*; D019781:Corneal Topography; D005260:Female; D006801:Humans; D006956:Hyperopia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications; D019736:Prostheses and Implants; D017755:Prosthesis Fitting; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
D019904:Polymethyl Methacrylate