Bilateral extrusion of Intracorneal ring segments 9 years post implantation

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Bilateral extrusion of Intra-corneal ring
segments 9 years post implantation

• Nisha R. Patel, MD, Barrie D. Soloway, MD,
• P. Giordana Avila, OD
• New York Eye and Ear Infirmary
• Vista Alliance Eye Care Associates
• New York, NY

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Case Report

• A 50 year-old Caucasian male presents with
  sudden-onset foreign body sensation after
  episodic eye rubbing. He reports having scratched
  his right eye while swimming 6 months prior, and
  felt that it never fully healed.
• Ocular history was significant for Intacs OU 10
  years ago DV OD, NV OS. Medical, social and
  family history were all noncontributory and his
  medications included Genteal gel qAM OD and
  antibiotic drops OD qid, initiated by the
  referring physician, as well as a bandage contact
  lens, also initiated by the referring physician.
  
• Examination revealed a visual acuity of OD 20/40,
  OS 20/150, brisk pupils with no RAPD in either
  eye. Motility was full and the patients
  refraction was OD 1.00-2.50 x 23, OS -1.75-0.50
  x 105.
• Slit Lamp Exam 1 conjunctival injection OD, 50
  extrusion of the anterior surface of the temporal
  ICRS in the right eye with focal thinning and few
  SPK along its border. The other ICRS in the right
  eye, as well as both ICRS in the left eye, were
  in the anterior 25 of the cornea.
• Both segments were removed OD. His contra lateral
  eye suffered the same extrusion 8 months later
  and both segments were removed from the left eye.

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Case Report

• Over a period of 9 months following the removal
  of the INTACS OD, the patient developed
  increasing with-the-rule astigmatism of 6.0D due
  to apparent ectasia, except at 12 and 6 oclock,
  where there were no segments.
• After 11 months, his cornea stabilized and his
  astigmatism improved.
• The left eye experienced a 3.0D increase in
  astigmatism which improved after 3 months.

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Sequential Topographies OD
3 months post explantation Rx
-0.62 - 4.62 x 10
1 day prior to removal of Intacs OD Rx
1.00-2.50 x 23
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Sequential Topographies OD
5 months post explantation Rx -1.62 - 4.50 x 7
6 months post explantation Rx -0.62 - 6.12 x 14
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Sequential Topographies OD
11 months post explantation Rx -2.00 - 0.75 x 37
21 months post explantation Rx -3.75 - 0.87 x 14
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Sequential Topographies OS
3 months prior to explantation Rx -0.75 - 1.25 x
131
3 days prior to explantation Rx 1.75-4.50 x 143
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Sequential Topographies OS
2 months after removal of Intacs OS Rx -1.25 -
4.50 x 165
3 months post explantation Rx -2.25 - 3.37 x 170
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Sequential Topographies OS

• 13 months post explantation Rx -2.87 - 1.37 x
  145

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Case Report

• The patient was fit with rigid gas permeable
  lenses OU to achieve a BCVA of 20/20 in each eye
• At the most recent visit, almost 2 years after
  the initial extrusion in the right eye, the
  patient was re-fit with soft contact lenses.

8 months after removal of Intacs OD
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Conclusions

• ICRS are approved as safe and effective for
  long-term control of myopia and keratoconus.
• Anterior placement/ migration of these implants
  leads to overlying corneal tissue loss and
  extrusion.
• We emphasize the need for proper depth of
  placement at the initial surgery to avoid the
  long-term post operative complication of
  extrusion.
• Follow-up studies of patients beyond 3 months
  post-explantation may reveal further changes in
  refractive error.