title: Efficacy of intacs intrastromal corneal ring segment relative to depth of insertion evaluated with anterior segment optical coherence tomography.
abstract: OBJECTIVE
  To evaluate the effect of implantation depth of Intacs microthin prescription inserts (Addition Technology Inc, Fremont, California) on visual and topographic outcomes in patients with post- laser-assisted in situ keratomileusis (LASIK) ectasias.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  In this case series, 16 eyes of 12 patients were evaluated. All cases were post-LASIK ectasia that had undergone intrastromal corneal ring segment (ICRS) implantation. The planned insertion depth was 70% of stromal thickness using a manual dissector. At least 12 months postoperatively, all eyes underwent Visante (Carl Zeiss Meditec) AS-OCT to determine insertion depth. Cases were categorized into 3 groups based on the measured implantation depth: 40-59% thickness; 60-79% thickness; and ≥80% thickness. Visual, refractive and topographic outcomes were evaluated relative to implantation depth.
  
  
  RESULTS
  The lowest improvement in the study parameters ocurred when the implantation depth was ≥80%. In this group, uncorrected visual acuity (UCVA) and best spectacle corrected VA (BSCVA) improved less than 0.5 lines. Manifest refractive spherical equivalent (MRSE) and mean keratometry (Km) change was less than 0.5 diopters (D). The greatest improvements were observed with implantation depth of 60-79% where UCVA and BSCVA increased by 4.5 and 2.5 lines respectively, and MRSE and Km changed by approximately 2.00 D. Less improvement was found when ICRS were implanted between 40-59% of stromal thickness.
  
  
  CONCLUSIONS
  Implantation of ICRS greater than 80% of stromal thickness may have no effect on visual and topographic status.
authors.affiliation: Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran ; Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hassan
authors.initials: H
authors.lastname: Hashemi
authors.forename: Alireza
authors.initials: A
authors.lastname: Yazdani-Abyaneh
authors.forename: Amirhushang
authors.initials: A
authors.lastname: Beheshtnejad
authors.forename: Mahmood
authors.initials: M
authors.lastname: Jabbarvand
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kheirkhah
authors.forename: Seyed Reza
authors.initials: SR
authors.lastname: Ghaffary
mesh_terms: D000328:Adult; D003316:Corneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003319:Corneal Stroma / Q000473:pathology / Q000601:surgery*; D019781:Corneal Topography; D004108:Dilatation, Pathologic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
keywords: Intacs implantation depth; Laser-assisted in situ Keratomileusis; optical coherence tomography; post–lasik Ectasia; visual Acuity