I am wondering what the opinions are of people who have seen patients with intacs and ck after lasik induced ectasia.

I have seen 3 people and I am not greatly impressed that this is a real alternative to contact lenses. It may be an option for those who cannot tolerate contact lenses, but I have lost my enthusiasm for recommending this as an ALTERNATIVE to contact lenses....

Anyone else care to comment??

Jason

I do not think that there is any role for either Intacs or CK in post-LASIK ectasia. The role of Intacs in primary keratoconus is dubious at best, and has not to my knowledge been proposed by any ethical surgeon in the context of post-surgical ectasia. CK is in my opinion not a very good procedure for anything save perhaps the +1.00 presbyopic hyperope, and would be a terrible idea in the ectasia-post-LASIK patient.

Ectasia describes uncontrolled progressive corneal thinning and shape change (typically steepening over the thin areas) with consequent optical change, usually producting distortion and image degradation. Ectasia can arise in the absence of surgery (keratoconus, pellucid marginal degeneration, keratoglobus, etc.) or as a result of laser treatment removing enough tissue to compromise the biomechanical integrity of the remaining stroma.

Our profession needs to develop better means to stabilize structurally compromised tissue. In my mind, this means developing methods to (a) stimulate growth of new corneal collagen where needed; (b) stimulate overall hypertrophy of stroma leading to increased thickening and improved biomechanical stabiity; or (c) onlay donor tissue to reinforce thin, weak areas.

Intacs has never been suggested to stop ectasia even in the keratoconus patient, but is portrayed as as a poor man's substitute to any of the above. Intacs' manufacturer, Keravision, has been in and out of bankruptcy over the past few years and is still a procedure in search of a good indication. In over 11 years of doing LASIK I have referred one patient with mild keratoconus for consideration of Intacs, and that patient has (wisely, in my opinion) chosen to defer any surgery at all.

I cannot say too many nice things about CK. Remember "LTK" and how it tanked? Remember burning the cornea with a hot wire to effect local shrinkage? CK (formerly called RFTK or "radio-frequency thermo-keratoplasty") does exactly the same thing, without laser accuracy. To me, even the mere proposal of further damaging corneal collagen in an eye with ectatsia from any cause is grounds for demanding that the proponent stay after class and write "I will not do anything to damage the cornea" 1,000 times on the blackboard before being allowed to leave class.

I completely agree - stay with contacts for now!

David A. Wallace, M.D.
Medical Director
LA Sight
11600 Wilshire Blvd., Suite 200
Los Angeles CA 90025
310 828-2020
www.LA-Sight.com