intracorneal ring-segments-by-femtosecond-tunnel-creation
TRANSCRIPT
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Intracorneal Ring Segments By
Femtosecond Tunnel Creation
BY Dr. Amr Mounir Lecturer of ophthalmologySohag university
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Keratoconus is a progressive, noninflammatory, bilateral (but usually asymmetric) ectatic corneal disease.
Introduction
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Treatment modalities include hard contact lens, corneal collagen crosslinking, Intracorneal ring segments and Keratoplasty
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Intracorneal Rings
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Mechanism of action of rings
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Types of Rings
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Methods of implantation of rings
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- Precise Depth - Precise Incision site creation- Easier than manual - Avoid complications of manual tunnel creation
e,g: Anterior or Posterior corneal perforations , epithelial defects, infectious keratitis, asymmetric segment placement, corneal stromal oedema around the incision, extension of the incision towards the central visual axis or the limbus and persistent incisional gapping
Advantages of Femtosecond Tunnel Creation
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High errors.Mean Keratometry > 48 DsK Max > 50 DsBCVA < 6/30 High patient motivation
Ideal patient for rings
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Our provisional Experiencein Sohag
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Rings we use
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Parameters which guide us
- Refraction- Pachymetry - Steepest K axis - Cone site - Nomogram
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Non central cones.High cylinder.High difference between K1, K2.Thickness at insertion site >400
um
Kerarings
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Non of treatment options is satisfactory for the patient.
The disease is progressive by its nature.Follow up is mandatory.Combination of treatment options can be done.Keratoplasty can be a final destiny even with
treatment.Rings mostly will be followed by glasses.Don't judge on improvement of V\A without correction.Financial aspect should be taken into consideration.Rings results are unpredictable
Rules in treatment by rings
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Nomogram for Kerarings
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Tunnel creation by Femtosecond laser
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Kerarings Ring implantation
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Pre and post Kerarings Pentacam
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About 250 eyes had been operated with Keraringes implantation by Intralase technology
Our provisional experience in Sohag Femtocenter
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We ask ourselves very important question
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What are factors that affect the results of ring
implantation ????
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Age as a guideline
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A 23 ys female with bil. Keratoconus Rt. Eye is advanced more than Lt. eye.
Preoperative refraction of Rt. eye : -6.00 Ds -3.50 Dc
UNCVA : 4/60BCVA : 6/30
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Postoperative refraction of Rt. eye : -2.50 Ds -1.50 Dc
UNCVA : 6/30BCVA : 6/18
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Symmetry of Bowtie as a guideline
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A 37 ys male with bil. Keratoconus Rt. Eye is advanced more than Lt. eye.
Preoperative refraction of Rt. eye : -4.25 Ds -7.00 Dc
UNCVA : 3/60BCVA : 6/38
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Postoperative refraction of Rt. eye : +1.00 Ds -1.0 Dc
UNCVA : 6/38BCVA : 6/18
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Corneal thickness as a guideline
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A 17 ys male with RT. Advanced Keratoconus .
with thinnest location 348 um with max k: 60 D Preoperative refraction of Rt. eye : -15.00 Ds -8.00 Dc
UNCVA : 2/60BCVA : 6/60
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Postoperative refraction of Rt. eye : -7.50 Ds – 5.00 DcUNCVA : 6/60BCVA : 6/30
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Rings in advanced cases
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To delay corneal grafting.To make the eye refractable.To decrease coma aberrations.
N.B: Keratoplasty is still an option
Aim:
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Thank you