One or 2 Intacs segments for the correction of keratoconus

PURPOSE: To evaluate the effect of implanting 1 or 2 intracorneal rings (Intacs, KeraVision) as a device to correct, stabilize, and/or improve the best corrected visual acuity in patients with clear cornea keratoconus oriented by the preoperative corneal topography pattern. SETTING: Vissum/Instituto Oftalmológico de Alicante, Miguel Hernandez University, Alicante, Spain. METHODS: In this prospective comparative consecutive study, Intacs segments were implanted in 26 keratoconic eyes with clear central corneas of 19 consecutive patients (9 women and 10 men). Corneas were divided into 2 groups according to the topographic pattern of the cone. Group I included keratoconus not crossing the 180 degrees meridian and Group II included keratoconus crossing the 180 degrees meridian. The Intacs were horizontally placed through a lateral clear corneal incision. According to the corneal topography 1 segment was implanted 0.45 mm inferior in Group I, and 2 segments were implanted, 1 0.25 mm superior and the other 0.45 mm inferior, in Group II. All cases completed a minimum follow-up of 1 year. Differences between preoperative and postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, and keratometry were clinically and statistically evaluated. RESULTS: Spherical equivalent error and refractive astigmatism were significantly reduced. The mean keratometric values were reduced following Intacs insertion in both groups. At the end of the first year of the postoperative follow-up, Group I (1 segment) had an improvement in mean UCVA to 20/50 (0.4 +/- 0.22 decimal value), which was statistically significant when compared to the preoperative UCVA of 20/100 (0.2 +/- 0.13 decimal value) (P=.011). Mean BSCVA was 20/32 (0.62 +/- 0.24 decimal value), which was also statistically significant when compared to the preoperative BSCVA, which was 20/50 (0.4 +/- 0.21 decimal value) (P=.002). In Group II (2 segments), UCVA after 1 year was 20/63 (0.34 +/- 0.17 decimal value), which was statistically significant when compared to the preoperative UCVA of 20/400 (0.06 +/- 0.02 decimal value) (P=.001). Mean BSCVA was 20/32 (0.62 +/- 0.27 decimal value), which was significantly better than the preoperative UCVA of 20/50 (0.38 +/- 0.22 decimal value) (P=.001). In 4 eyes, the inferior segment was removed because of partial extrusion during the postoperative follow-up. CONCLUSIONS: Treatment of keratoconus with 1 or 2 Intacs segments oriented by the preoperative corneal topography used in this study proved to be effective in decreasing the corneal steepening and astigmatism and improving BSCVA. Further follow-up is needed to determine the final effect of Intacs on the progression of the corneal disease.