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Intracorneal Ring (ICR) implantation for keratoconus (KC): endothelial perforation during femtotunnel with transient localized hydrops: diagnostic and management
Session Title: Keratoconus and ectasia
Session Date/Time: Tuesday 08/10/2013 | 16:30-18:00
Paper Time: 17:37
Venue: Elicium 2 (First Floor)
First Author: : S.Leroux les Jardins FRANCE
Co Author(s): : G. Leroux Les Jardins
To describe microperforations during the use of Femtolaser to do the channel before the insertion of ICR"s for Keratoconus
Keratoconus grad 2 to 4
It is a retrospective study of 4 micro perforations out of our 87 first ICRs during Femtotunnel before the insertion of 5 mm Optical Zone (OZ) ICRs for keratoconus grade 3 and 4. Femto-laser used was IFis, AMO. The ICRs were chosen according to the Ferara Keraring Nomogram.
For the first case, micro perforation was diagnosed during the insertion of the ICR as a Seidel occurred. For the second case, small bubbles were visible during Femtotunnel and a seidel occurred during the implantation. For the third and the fourth cases, as small bubbles occurred during Femtotunnel, a Corneal OCT was made before the insertion of the ICR"s which showed obviously posterior corneal micro perforations . No ICR were inserted. A localized Hydrops occurred which resolved rapidly. None of these cases required corneal transplantation. For 3 eyes, a larger Optical Zone Femtotunnel was performed and a 6 mm OZ ICR was inserted after six months near the site of the microperforation.
Small "Champaign" bubbles in the Femtotunnel seem to be a pathognomonic sign of micro perforations not described until now. To confirm the diagnostic and avoid the ICRs insertion, OCT is a very useful tool. It is possible to diagnose micro perforations during Femtotunnel when there are small bubbles in the tunnel. Than OCT performed after the procedure confirmed the microperforation. ICRs insertion has to be postponed to avoid complications. ICRs insertion is nevertheless possible after six months with the use of a larger ICRs Optical Zone.