EyeWorld Asia-Pacific March 2016 Issue

56 EWAP DEVICES March 2016 “There is a certain biomechanical effect with ICRS that could modify disease progression, and there is also a certain flattening effect with CXL that could help in terms of uncorrected visual acuity, but those are not their main objectives nor indications while deciding the treatment algorithm. ICRS and CXL are treatment options that will complement each other and are not meant to replace each other.” Dr. Kilic maintains ICRS can provide good outcomes, but notes CXL and rings together have the added advantage of helping maintain stability. What Intacs and Intacs SK cannot do If the keratoconic patient has developed scarring, “you’re likely to have reduced distance/near corrected visual acuity and may find the cornea too thin for CXL or Intacs,” Dr. Jackson said. “When I see scarring, I immediately start thinking keratoplasty if a contact lens does not give the patient adequate vision to function.” For these patients, functional vision is determined individually based on a patient’s occupational and recreational needs. Dr. Kilic limits the implantation area in cases of severe corneal scarring to a minimal 450 microns. “In these cases, however, I typically do not recommend ICRS. I prefer keratoplasty for those patients,” she said. Finally, there remains the challenge that, long term, “patients with keratoconus can still progress despite having Intacs, so CXL is an important consideration for patients who have received Intacs for keratoconus,” Dr. Trattler said. EWAP References 1. Sharma M, et al. Comparison of sin- Treating keratoconus - from page 55 gle-segment and double-segment Intacs for keratoconus and post-LASIK ectasia. Am J Ophthalmol . 2006;141:891–895. 2. Yeung SN, et al. Efficacy of single or paired intrastromal corneal ring segment implantation combined with collagen crosslinking in keratoconus. J Cataract Refract Surg . 2013;39:1146–1151. Editors’ note: The physicians have no financial interests related to this article. Contact information Jackson: mjlaserdoc@msn.com Kilic: aylinkilicdr@gmail.com Perez: mauricioperezvelasquez@gmail.com Trattler: wmtrattler@gmail.com