A slitlamp examination reveals wellpositioned intrastromal corneal ring segments oriented at 90. Cataract surgery in an eye with intrastromal corneal ring. May 09, 2018 intrastromal corneal ring segments icrs are small curvilinear segments made of synthetic material that are implanted deep in the corneal stroma to alter the corneal curvature. Postoperative corneal asphericity values demonstrated that intrastromal corneal ring segments intacs produced a prolate aspheric surface for myopic correction from 1. Intracorneal ring segments for iatrogenic keratectasia after laser in situ keratomileusis or photorefractive keratectomy. Management of keratectasia with intrastromal corneal ring segments. Intrastromal corneal ring segments consist of microthin soft plastic inserts of variable thickness that are placed in the periphery of the cornea.
An intrastromal corneal ring segment icrs is a small device implanted in the eye to correct vision. Intrastromal corneal ring segments consist of microthin methylmethacrylate inserts of variable thickness that are placed circumferentially into twothirds depth of the peripheral corneal stroma. Watch instructional videos on corneal procedures, including penetrating and partial thickness keratoplasty, collagen crosslinking, and pterygium removal. One could simply proceed with cataract surgery after warning the patient that there is a greaterthanusual chance of not achieving the refractive target because of the altered cornea. Keratoconus is a corneal degeneration that usually appears during puberty and may seriously deteriorate the quality of life of the patients. Dec 29, 2016 intrastromal corneal ring segments icrs are a reversible, powerful and useful therapeutic option for the visual rehabilitation of patients with corneal ectatic disorders, including keratoconus. Reversibility and exchangeability of intrastromal corneal ring segments. Intrastromal corneal ring segments intacs is a nonlaser procedure that involves implanting two tiny plastic arcs in the cornea. Video abstract of an original research vector analysis of astigmatism in keratoconic eyes after combined intrastromal corneal ring segments implantation and. Mix of implantation 2 different intrastromal corneal ring segments. Comparison of mechanical and femtosecond laser tunnel creation for intrastromal corneal ring segment implantation in keratoconus. Jun 04, 2011 mix of implantation 2 different intrastromal corneal ring segments. Intrastromal corneal ring segments intrastromal corneal ring segments are composed of microthin soft plastic inserts of variable thickness that are placed in the periphery of the cornea.
Implantation of intrastromal corneal ring segments icrs is an effective and. Intrastromal corneal ring segments for keratoconus 3 1. To assess the effectiveness and safety of 2 types of 6. Intrastromal corneal ring segments for astigmatism correction. Intrastromal corneal ring segments keraring were implanted for keratoconus correction after corneal tunnel creation with the aid of femtosecond laser intralase corp, irvine ca. The most recent examination occurred between 4 to 18 months mean, 10. Two months after surgery in the second eye, she complained of. Alpins victorial analysis in keratoconus video abstract. Ferrara intrastromal corneal ring segments for severe keratoconus.
Intrastromal corneal ring implants are considered investigational for all other conditions and applications. Keratitis after implantation of intrastromal corneal ring. To learn if you are a candidate for intrastromal corneal rings, please contact benjamin eye institute today at 310. They are inserted through an incision made in the cornea, into which channels have been created by rotating a lamellar dissector or by using a femtosecond laser. Evaluation of intrastromal corneal ring segments for.
Intrastromal corneal ring segments for keratoconus 03. There have been several management options discussed for keratoconus including collagen crosslinking cxl, topography guided ablation, intrastromal corneal ring segment icrs implantation and keratoplasty. Intrastromal corneal ring segments icrs for keratoconus. The procedure involves an ophthalmologist who makes a small incision in the cornea of the eye and inserts two crescent or semicircular shaped ring segments between the layers of the corneal stroma, one on each side of. Refractive and visual outcomes after keraring intrastromal. Created from donor corneoscleral rim tissue, the corneal allogenic intrastromal ring segments cairs are a biocompatible, reversible and adjustable solution for corneal ectasia, with numerous advantages over synthetic implants. Intrastromal corneal ring segments delhi j ophthalmol 20. Case report in june 2007, a 9yearold white boy was referred to the eye department by his optician for bilateral watery photophobic eyes and blurred vision. Her preliminary data suggests that the technique offers patients significant anatomic and visual benefits. Deep corneal neovascularization after implantation with. They have been investigated for two indications, refractive surgery to correct mild myopia and as a treatment of keratoconus. This study indicated that the range of corneal asphericity measured in these 25 eyes, before and after surgery, provided good visual acuity and.
Another treatment option for keratoconus or postlasik ectasia is intrastromal corneal ring segments icrs, such as intacs 1 and kerarings 2 intrastromal corneal ring segments are thin plastic arcs that can be implanted in the corneal stroma through a small surgical incision on the cornea and they help restore clear vision in keratoconus patients by flattening and repositioning the cornea. Intrastromal corneal ring segments for ectasia and keratoconus v executive summary the procedure intrastromal corneal ring segments icrs are small semicircular plastic segments that are inserted, usually under topical anaesthesia, into stromal channels outside the central visual axis of the eye to reinforce the corneal stroma. The purpose of the study was to evaluate the safety and efficacy of the intrastromal corneal ring segments icrs for the correction of myopia. Ferrara intrastromal corneal ring segments for severe. They are polymethyl methacrylate pmma ring shaped devices that are inserted within the corneal stroma, inducing a flattening of the central corneal. Now, we have a new generation of devices for keratoconus treatment. This article is from indian journal of ophthalmology, volume 62. Changes in keratoconic corneas after intracorneal ring segment explantation and reimplantation. A 31yearold woman with keratoconus underwent uneventful sequential implantation of intrastromal corneal ring segments intacs aided by femtosecond laser performed 6 weeks apart.
Since the inferior cornea was thinner than the depth of the planned intrastromal channels, a novel technique had to be developed to prevent the penetration of the femtosecond laser beam into the anterior chamber. Intrastromal corneal ring segments can be readily removed from the cornea, if required. In this case, the refraction returned to its preoperative state soon after the explant procedure and. He was intolerant of rigid gaspermeable contact lenses and eventually chose to have placement of intrastromal corneal ring segments icrs intacs in the right eye. Intracorneal ring segments icrs have been investigated recently as a surgical alternative to correct ectatic corneal diseases. Arantes,1 sandro coscarelli,2 paulo ferrara,3 luana p. Pdf the use of intracorneal ring segments in keratoconus. Intrastromal corneal ring segments have several distinct and important advantages. Intrastromal corneal ring segments icrs are small curvilinear segments made of synthetic material that are implanted deep in the corneal stroma to alter the corneal. We evaluate the efficacy and safety of keraring 355 intrastromal corneal ring.
Dec 03, 2010 intrastromal corneal ring segments intacs eyesmart american academy of ophthalmology. Implantation of intrastromal corneal ring segments youtube. Comparison of 2 types of intrastromal corneal ring segments. Intrastromal corneal ring segments combined with collagen cross. This corneal disease is today the first indication of corneal transplantation in young patients. Intrastromal corneal ring segments combined with collagen cross linking for the treatment of keratoconus.
Intrastromal corneal ring segment implantation in 409 paracentral keratoconic eyes. Intrastromal corneal ring segments have been investigated as a means of improving vision in diseases such as keratoconus, pellucid marginal degeneration, and for refractive surgery to correct myopia. Intrastromal corneal ring segment implantation keraring 355 in. Intrastromal corneal ring segments for keratoconus. Request pdf correction of astigmatism with short arclength intrastromal corneal ring segments preliminary results to evaluate the refractive effect of. Effectiveness of intracorneal ring segments for keratoconus. The use of intracorneal ring segments in keratoconus eye. Intrastromal corneal ring segments for keratoconus 0312. Intrastromal corneal ring segments combined with collagen. Table 1 summarizes the main characteristics of these icrs. The length of time the segments remained in the cornea after initial surgery varied from 6 to 15 months mean, 10. In addition, there are two other types of icrs that because of their smaller diameter and. Decision making nomogram for intrastromal corneal ring.
Biologic stromal ring to manage stromal melting after. Full text intrastromal corneal ring segments implantation and. Intrastromal corneal ring segment implantation keraring 355 in patients with central keratoconus. To evaluate the effect of removal andor exchange of intrastromal corneal ring segments icrs, intacs. Studies have demonstrated the efficacy of intrastromal corneal rings intacs, keravision to correct low myopia by flattening the center of the cornea. A 33yearold man who was 2 years post laser in situ keratomileusis was found to have corneal ectasia.
Pdf intrastromal corneal ring segment implantation for. Intrastromal corneal ring segments for astigmatism correction after deep anterior lamellar keratoplasty julio c. Alio, 1, 2 alfredo vegaestrada, 1, 2 santiago esperanza, 1, 2 rafael i. We describe a case in which the use of intrastromal corneal ring segments icrs provided near normal spectaclecorrected vision in an 11yearold boy. Modification of the intrastromal ring position according. A 2year phase ii clinical trial of icrs was initiated in may 1995.
These crescents are placed in the outer edge of the cornea and opposite each other. Management of keratectasia with intrastromal corneal ring. Intrastromal corneal ring segments icrs for keratoconus and. When placed, intacs stretch the cornea to make it flatter.
Pdf characterization of the effect of intracorneal ring. Correction of astigmatism with short arclength intrastromal corneal. Intracorneal ring segments implantation for corneal ectasia. Keratoconus is an ectatic disease of the cornea characterized by localized progressive thinning and forward protrusion of the cornea. To verify possible correlations between the biomechanical state of the cornea before surgery and the results of stromal ring segment implant for keratoconus. Reversibility and exchangeability of intrastromal corneal.
Rating is available when the video has been rented. Outcomes of a 320degree intrastromal corneal ring segment. Fortythree eyes with central keratoconus with a corneal asphericity value 1. Intrastromal corneal ring segments icrs are small, semicircular devices that are implanted circumferentially into the corneal stroma to flatten the cornea. Alio jl, artola a, ruizmoreno jm, hassanein a, galal a, awadalla ma. Correcting keratoconus with intracorneal rings sciencedirect. We believe ours is the first technique to use biologic segments to reverse melting and maintain the optical effect of the pmma. Longterm followup of intrastromal corneal ring segments.
Intacs, addition technology, fremont, california are used to correct low to moderate myopia, 1 keratoconus, 2 and ectasia after laserassisted in situ keratomileusis lasik. Intrastromal corneal ring segments implantation and corneal. The lasik flap was made with a superior hinge and had a larger diameter than the intacs diameter, so it was not disrupted by the incision for intacs insertion. Extrusion of femtosecond laserimplanted intrastromal corneal. The cornealring is a new model with a lot of advantages comparing it with the triangular old model rings. Pdf vector analysis of astigmatism in keratoconic eyes after. However, collagen crosslinking plus intrastromal corneal ring segment resulted in an additional improvement of uncorrected distance visual acuity of 0. Laser in situ keratomileusis results after intrastromal corneal ring segments intacs. An intrastromal corneal ring segment icrs also known as intrastromal corneal ring, corneal implant or corneal insert is a small device implanted in the eye to correct vision. Jadidi k, mosavi sa, nejat f, naderi m, janani l, serahati s. Implantation of intrastromal corneal ring segments is considered not medically necessary as a treatment of myopia when performed solely to eliminate the use of refractive lenses eye glasses or contacts. Could icrs implantation impact visual rehabilitation of keratoconus.
Intacs are made of two semicircles of plastic that rest between the layers of tissue in the cornea. The ferrara icrs have been used largely in several countries for the treatment of primary and secondary ectatic. An incision was made at the temporal cornea, and 2 intrastromal corneal ring segments were implanted in the corneal midperiphery a 0. Characterization of the aspheric corneal surface with. Intrastromal corneal ring segments keratoconus support and. Adjustability of refractive effect for corneal ring segments.
Nowadays, there are different types of icrs commercially available, but the ones that are used more in the clinical practice are keraring mediphacos fig. Ring segment extrusion is one of the late complications of icrs implantation. Corneal allogenic intrastromal ring segments cairs. How successful is the surgical treatment of keratoconus. To assess the visual and refractive outcomes of implantation of intrastromal corneal ring segments icrs in keratoconic eyes with no coincident topographic and comatic axes.
Intrastromal corneal ring segment wikimili, the free. Araujo,4 marcos avila,1 and leonardo torquetti5 1center of reference in ophthalmology, federal university of goias, goiania, brazil. There is a significant improvement in visual acuity and keratometric parameters after intrastromal corneal ring segments icrs for keratoconus. Abstractpurpose to create a nomogram for the insertion of intrastromal corneal ring segments. Intrastromal corneal ring segments intacs university of. Intrastromal corneal ring segments, keraring, keratoconus keratoconus is a progressive, noninflammatory, bilateral corneal ectasia with an estimated prevalence of 1 in 2000. The procedure involves an ophthalmologist who makes a. Until the last decade of the xx century, keratoplasty procedures were the only alternative to treat this pathological condition. Intrastromal corneal ring segments keratoconus support. Intrastromal corneal ring segments for postlasik ectasia. To assess the longterm outcomes of implanting intrastromal corneal ring segments icrss to correct central keratoconus with a high corneal asphericity value. Intrastromal corneal ring segments icrs for vision correction. Jun 17, 2019 intrastromal corneal ring segments implantation and corneal crosslinking for keratoconus in children with vernal keratoconjunctivitis threeyear results mortada ahmed abozaid,1 amin aboali hassan,1 abdelsalam abdalla2 1department of ophthalmology, faculty of medicine, sohag university, sohag, egypt.
The intrastromal corneal ring segments have been in the eyes for 17 years now and are not causing any problems at all. Several studies have demonstrated the efficacy of intrastromal corneal ring segments icrs in both keratoconus3,4 and post laserassisted in situ keratomileusis lasik ectasia. Giacomin nt, mello gr, medeiros cs, kili a, serpe cc, almeida hg, karajunior n, santhiago mr. Implantation of intrastromal corneal ring segments is considered not medically necessary as a treatment of myopia when performed solely to eliminate the use of refractive lenses eye glasses or contacts intrastromal corneal ring implants are considered investigational for all other conditions and applications also see the separate policies regarding phototherapeutic keratectomy, policy 09. Corneal allogenic intrastromal ring segments cairs combined.
Mortada ahmed abozaid,1 amin aboali hassan,1 abdelsalam abdalla2. Allogenic intrastromal ring segments for corneal ectasia. The procedure involves an ophthalmologist who makes a small incision in the cornea of the eye and inserts two crescent or semicircular shaped ring segments between. Corneal rings, also called corneal ring segments or intrastromal corneal ring segments icrs, are small plastic devices implanted to alter the shape of the front portion of the eye to provide you with clear vision.