ESCRS - PO136 - New Approaches Of Intracorneal Ring Segments Implantation For Asymmetric Keratoconus Treatment: A Case Series

New Approaches Of Intracorneal Ring Segments Implantation For Asymmetric Keratoconus Treatment: A Case Series

Published 2024 - 42nd Congress of the ESCRS

Reference: PO136 | Type: Case Report | DOI: 10.82333/szf9-0206

Authors: Jordana Sandes 1 , Bernardo moscovis 2 , Fernando Heitor de Paula* 3

1Cornea,Federal university Goias ,goiania,Brazil, 2corneal,Unifesp,São Paulo,Brazil, 3Cornea,Federal University Goias,Goiania,Brazil

Purpose

Describing a new approach with the implantation of 2 concentric rings for the treatment of very asymmetrical keratoconus cases

         Design and Methods: Case series. This prospective, observational, single-center study evaluated the clinical outcomes of implanting two concentric ICRS in one eye. 

 

 

Setting

Conclusion: The association of concentric intrastromal ring segments in keratoconus corneas induces a significant anterior corneal flattening, resulting in refractive changes, a notable reduction in its prolate shape and irregularity, and improvement in patient CDVA. Taking advantage of its versatility, reversibility, and adjustability, it could be a promising option for highly asymmetric and advanced KC, potentially avoiding or postponing the need for transplants. 

Report of case

CONCENTRIC 210° 5 MM INTERNAL AND 140°5 MM EXTERNAL RINGS

A 40 years patients with incipient keratoconus in RE and keratoconus grade 4 in LE, intolerant to contact lenses, underwent surgery in other service . The patient reported impaired visual acuity, concluding that the previous ICRS was ineffective.

 

Refraction after the implant of 140° arc ring in LE:

OD: +0.50 -2.75 95 20/20

OS: -4.75 -3.75 75 20/50      

 

A new approach was then performed: one 210°/20 ICRS (5 mm) was inserted internally concentric to the previous ICRS to flatten the most curved region and improve the corneal regularity. After the procedure, the patient presented an important corneal flattening, mainly in the central region, leading to a significant visual improvement (Figure 3).

Post first implant:

OE: -4.75 -3.75 75 20/50

Post the second implant:

OE: -2.00 -4.00 60° 20/20P

 

 

 

 

 

 

 

 

 

 

 

Conclusion/Take home message

 

The treatment of keratoconus has significantly changed in recent years. Several treatments may mitigate the progression and change the corneal curvature safely and effectively, providing optimal visual results in patients with keratoconus. Future studies may improve the safety and effectiveness of keratoconus treatments and combined protocols.