These 2 presentations will be made during the ESCRS in Barcelona Spain later this month.

Postincisional and nonincisional ectasia improvement on quality of vision on patients treated with new technique of Intacs placement

Author Mark Swanson, M.D.
Swann Instituto
Swanninstituto@yahoo.com

PURPOSE: To improve the quality of vision on patients with ectasia with an easy and reproducible technique avoiding the complications of pernetrating keratoplasty

SETTING: Swann Instituto Facilities in Agua Prieta Sonora Mexico

Patients with incisional and non-incisional Ectasia

METHODS: Surgical technique is based on locating the INTACS inserts on the flattest axis of the refractive error, making the incision on the steepest axis, using 150° arc length inserts with different sizes (0.250, 0.300, 0.350, 0.400, and 0.450 mm) according to a nomogram designed for this technique using the INTACS Instrumentation from Addition Technology, Inc. The surgery was performed on post-surgical ectasia, pellucid marginal degeneration and keratoconus patients with mild to severe forms (Stage I, Stage II and Stage III), excluding the patients with central corneal scarring, hydrops, and severe thinning of the cornea (300 microns or less).

RESULTS: 140 surgeries were performed. Follow-up was 1 to 14 months. Keratoconus patients' UCVA improved to 20/40 or better in 100% of the mild cases and in 55% of the moderate to severe cases. Uncorrected visual acuity improved to 20/20 or better in 62% of the mild cases and in 20% of the moderate to severe cases. BSCVA improved to 20/30 or better in 100% of the mild cases, 90% of the moderate cases and 62% of the severe cases. One hundred percent (100%) of the patients gained (1 or more) lines of vision while 70% of the severe cases gained 3 or more lines of vision. Stage III keratoconic patients appeared to be the group that benefited most from the procedure, however 100% of the patients improve their quality of vision on post-incisional and non-incisional ectasia.

CONCLUSIONS: This new technique placement changes the architecture of the cornea to a more prolate aspheric shape, decreasing or eliminating aberrations and the refractive error, stabilizes and adds rigidity to the cornea, creating a better optical surface thereby improving both the quality of vision and the quality of life of these patients.

FINANCIAL: None



Lamellar Keratoplasty with Moria microkeratome flap and Intacs for severe keratoconus

Author Mark Swanson, M.D. Swanninstituto@yahoo.com
Swann Instituto

Abstract

PURPOSE: To pursue a surgical option for the treatment of severe keratoconus, avoiding the complications of penetrating keratoplasty.

SETTING: The surgery was performed on Swann Instituto Facilities patients. Candidates for penetrating keratoplasty with severe keratoconus were selected.

METHODS: A tunneling procedure was performed with Addition Technology 10 step system Instrumentation and a 100-micron head Moria microkeratome was used to performed a flap with a nasal hinge and the Intacs were placed on the tunnels. A 100 or 250 microns lamellae was placed on the stromal bed, the flap was repositioned and 5 interrupted sutures were placed temporally superiorly and inferiorly.

RESULTS: 100% of the cases gained lines of vision--20/50 uncorrected visual acuity on 40% of the cases and 20/30 best corrected on 90% of the cases.

CONCLUSIONS: Recovery is in 24 hours, uncorrected and best corrected visual acuity improves. The corneal thickness is 100 or 200 microns more and we avoid the complications of penetrating keratoplasty.

FINANCIAL: none