ICRS implantation with the Femto LDV laser in stabilized KC patients: 6 months results

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1 ICRS implantation with the Femto LDV laser in stabilized KC patients: 6 months results Jérôme C. VRYGHEM, M.D. Brussels Eye Doctors Brussels, Belgium No financial interest!

2 A lot of KC patients show interest in surgical visual revalidation techniques Stable KC patients - After UV-CXL - Older patients with stable KC Contact lens intolerance The aim = Near emmetropia!!!!!

3 My experience Implantation of Artisan IOL s Since 1991: surgeries Topography-guided guided surface ablations Since 2003 Using the WaveLight excimer laser and its T-CAT software Intra-corneal Ring Segments (ICRS) Since 3/2010 Using Kerarings + Ziemer LDV laser

4 My experience Intracorneal Ring Segments ICRS in 14 eyes of 13 patients: 1 segment: 10 patients 2 segments: 4 patients Previous SVR surgery in 4 eyes 11 eyes (of 10 patients) with follow-up of 6 months Mean age: 34 y (range 23 to 49 y) Sex ratio: Female: 2 patients / Male: 12 patients

5 My experience Intracorneal Ring Segments ICRS in 14 eyes of 13 patients My choice: Kerarings (Mediphacos) Triangular shape with prismatic effect: more effect, less reflections Two models: SI-5 and SI-6 Variable OZ: 5.0, 5.5 and 6 mm Variable arc lengths and thicknesses Greater refractive correction Other options: Ferrara rings, INTACS

6 My experience Intracorneal Ring Segments BCVA: 0.6- with

7 My experience Intracorneal Ring Segments Intra-corneal tunnels made by Ziemer FEMTO LDV Femtosecond laser On line advice Precise depth, position and length of the tunnel(s) Higher predictability

8 Ziemer FEMTO LDV LCS Handpiece: Unique integrated TopView Camera: Real-time image of applanated eye High resolution and colored images Fixed focus at 500 µm Centration marks Shifting of trajectory possibility Automatic pupil detection Built-in fixation light My experience Intracorneal Ring Segments

9

10 Adjust center of trajectory to spot marked on the eye by touching the arrows

11 ICRS Case 1 BCVA: 0.9- with BCVA: 0.6- with ICRS

12 ICRS Case 2 BCVA: 1.0- with 20 BCVA: 0.9+ with 55 BCVA: 0.5- BCVA: 0.7+ with 20 ICRS with 60

13 ICRS Case 3 UCVA: 0.63 BCVA: 1.2 with 11 ICRS UCVA: 0.63 BCVA: 1.2 with 13

14 ICRS Case 4 UCVA: 0.1 BCVA: 0.4 with 65 ICRS UCVA: BCVA: 0.3- with 120

15 ICRS Retrospective Study Parameters for follow-up: BCVA and UCVA Refraction Keratometry: Central and K max (Pentacam) Pachymetry: Central (HS interferometer) and thinnest (Pentacam) Topography: Topolyzer, Pentacam and Orbscan Pupillometry (Procyon) Methods Specular microscopy (Topcon) Subjective evaluation of the results using a questionnaire

16 ICRS Retrospective Study Results No major complications during surgery In one eye : insertion was difficult no impact on visual results Learning curve!!!!

17 ICRS Retrospective Study Results Mean BCVA and UCVA n = 11 V.A. Range 0.6 to 1.25 Range 0.2 to 1.20 Range 0.3 to 1.2 Range 0.15 to 1.0 Range 0.3 to 1.0 Range 0.05 to 0.7 Range 0.10 to 0.7 Range 0.05 to 0.60

18 ICRS Retrospective Study Results Mean spherical equivalent n = 11 sphere (D)

19 cylinder (D) ICRS Retrospective Study Results Mean astigmatism n = 11 Range -10 to +1.25

20 ICRS Retrospective Study Results Safety n = 11 BCVA 1/11 lost 2 lines BCVA

21 ICRS Retrospective Study Results Efficiency n = 11 UCVA 1/11 lost 2 lines UCVA

22 ICRS Retrospective Study Results Global satisfaction n = 11

23 ICRS in stabilized KC patients Conclusion Encouraging results when implanting ICRS in selected keratoconus patients Tunnel resections with the FEMTO LDV are easy, precise and reliable Patient expectations have to be realistic: contact lenses give better visual quality

24 Surgical visual rehabilitation techniques TG-PRK in low spherical equivalent, UV-CXL is mandatory in a 2 nd stage as fine tuning tool PIOL in high myopia and astigmatism in centered conus with good BCVA ICRS in Keratoconus Conclusion in myopia and higher astigmatism in decentered conus with slightly lower BCVA J. C. Vryghem SVR in KC Expert Meeting Vienna 2011

25 Surgical visual rehabilitation techniques in Keratoconus Conclusion Patients who underwent ICRS Conus has been recentered and regularized Less near emmetropia Halo s s +++, but not that disturbing Acceptable satisfaction rates J. C. Vryghem SVR in KC Expert Meeting Vienna 2011

26 Surgical visual rehabilitation techniques in Keratoconus Conclusion Patients who underwent implantation of a PIOL Cornea remains untouched, but high predictability of the refractive outcome Higher independence towards glasses or contact lenses Nearly no side effects Higher satisfaction rates, mostly due to correction of their high ametropia J. C. Vryghem SVR in KC Expert Meeting Vienna 2011

27 Surgical visual rehabilitation techniques in Keratoconus Conclusion Combination of all techniques is possible Slight preference for PIOL in higher ametropias TG-PRK in lower ametropias, can be used for fine tuning, if needed, after PIOL. ICRS : less predictable, but sometimes surprisingly good results, halo s but not that disturbing! If everything has failed: DALK or PKP

28 Surgical visual rehabilitation techniques The 2011 KC surgeon has to offer all treatment options to his patients: UX-CXL Phakic (toric) IOL s in Keratoconus Conclusion PRK but topography-guided ICRS, inserted in femtosecond laser made tunnels (for ex. with the Ziemer FEMTO LDV)

29 THANK YOU FOR YOUR ATTENTION!

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