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INTACS – PKP Comparison

INTACS – PKP Comparison. Intacs. Transplant. -0.75. +8.00 X -2.00 X 180°. Current Surgical Options - Keratoconus. 10% to 20% of Keratoconus Patients Ultimately Require Surgery Lamellar Keratoplasty Interface haze limits visual result Penetrating Keratoplasty

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INTACS – PKP Comparison

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  1. INTACS – PKP Comparison Intacs Transplant -0.75 +8.00 X -2.00 X 180°

  2. Current Surgical Options - Keratoconus • 10% to 20% of Keratoconus Patients Ultimately Require Surgery • Lamellar Keratoplasty • Interface haze limits visual result • Penetrating Keratoplasty • Most frequent procedure – 4,771 cases in 2004 (US) • 80-90% successful • Issues • Graft rejection rate 17.9% • Continued astigmatism • Endothelial cell loss (limited longevity of graft) • Recurrence of Keratoconus

  3. Surgical: Central Endothelial Cell Density Studies • Normal: 0.3% - 1.0% Cell loss/Year • PRK: 1.6% - 9.0% Cell loss/Year • LASIK: 0.1% - 1.0% Cell loss/Year • INTACS: 0.2% - 0.5% Cell loss/Year

  4. CORRECTIVE SURGERY: Central Endothelial Cell Density Studies • Cataract: 2.5% Cell loss/Year • Keratoplasty: 7.8% Cell loss/Year

  5. PKP Irreversible Procedure Time: 1 Hour Rehab Time: 12-18 Months Intraocular Procedure Lifetime Follow-up Complications Cataract, Glaucoma Endophthalmitis Rejection Expulsive hemorrhage Corneal ulcer Neovascularization Induced astigmatism Disease recurrence Risk of viral transference INTACS - PKP Comparison INTACS • Removable Out-Patient Procedure • Time: 20-30 Minutes • Rehab Time: 1-2 Weeks (Visual Function Immediate) • Corneal Lamellar Procedure • Periodic Follow-up • Complications • Unsatisfactory ring placement • Segment extrusion • Infection (Easily managed with segment removal)

  6. PKP INTACS - PKP Comparison INTACS • Endothelial cell loss, not clinically significant1 • Provides structural integrity, PKP still an option without complication • Outcomes: predictable, case dependent 1Two-Tear Endothelial Cell Assessment following INTACS implantation, Azaretal, J Refract Surg. 2001 Sept-Oct • Significant loss of endothelial cells • Permanently weakened cornea with risk of additional trauma • Outcomes: unpredictable, often unstable

  7. Conclusions: INTACS Intervention Superior to Transplant • INTACS restore functional vision • Functional refraction with soft, soft-toric, or rigid contact lenses is likely • Creates cornea more receptive to contact lenses • INTACS reduce corneal coning • Central cone is flattened • Asymmetrical cones are repositioned centrally • INTACS post-surgical recovery • Visual improvement can be immediate • Vision stabilizes in months rather than a year or longer • High potential to defer transplant

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