Late Infectious Keratitis After Intrastromal Corneal Ring Segments Implantation with Femtosecond Las

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Late Infectious Keratitis After Intrastromal
Corneal Ring Segments Implantation with
Femtosecond Laser.

• Mohamed H. Shabayek MD, MSc.
• Jorge L. Alio MD, PhD.
• UNIVERSIDAD MIGUEL HERNÁNDEZ
• VISSUM
• INSTITUTO OFTALMOLÓGICO DE ALICANTE
• SPAIN
• NO FINANCIAL INTEREST

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INTRODUCTION

• Intrastromal corneal ring segments (ICRS) are
  implantable PMMA segments, recently used for
  correction of ectatic corneal diseases
  Keratoconus, Pellucid marginal corneal
  degeneration and Post LASIK ectasia.
• The aim, is to delay if not avoid corneal
  grafting in ectatic corneal diseases with clear
  cornea.
• Two types are commercially available, Intacs
  KERARING.

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INTRODUCTION

• KERARING, which is originally designed by Pablo
  Ferrara is recently investigated as an
  alternative for correcting corneal ectasia.

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PURPOSE

• To report unilateral infectious keratitis in 48
  years old, keratoconic female patient with
  bilateral KERARING segments implantation after
  tunnel creation with the femtosecond laser
  (IntraLase).

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CLINICAL CASE

• A 48 years old female patient, with bilateral
  keratoconus and contact lens intolerance.
• Preoperative data
• BSCVA
• OD 0.4 with -6.50 D / -6.50 D axis 75.
• OS 0.4 with -7.25 D / -1.25 D axis 125.
• Pachymetry
• OD 440 µm.
• OS 460 µm.

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CLINICAL CASE

• Preoperative Videokeratography
• OD Grade IV Keratoconus
• K max 55.35 D.
• K min 47.22 D.
• Avg. K 51.29 D.
• Coma-like 6.62µm

• OS Grade II Keratoconus
• K max 51.60 D.
• K min 44.84 D.
• Avg. K 48.16 D.
• Coma-like 3.28µm

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CLINICAL CASE

• Surgical Planning
• Two asymmetrical segments
• Upper and nasal 0.25 mm.
• Lower and temporal 0.35 mm.
• OD
• Incision 120
• OS
• Incision 045
• Femtosecond Laser IntraLase.

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CLINICAL CASE

• Parameters Femtosecond Laser IntraLase 15 KHz
• Inner diameter 4.8 mm.
• Outer diameter 5.4 mm.
• Incision length 1.0 mm.
• Tunnel energy 5 mJ.
• Incision energy 5mJ.
• Implantation depth 400µm.

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CLINICAL CASE

• Postoperative data 1 month
• UCVA
• OD 0.2
• OS 0.6
• BSCVA
• OD 0.6 with -7.00 D / 0.00 D axis 75.
• OS 0.8 with 0.00 D / -1.50 D axis 120.

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CLINICAL CASE

• OS
• K max 45.21 D.
• K min 45.94D.
• Avg. K 45.58 D.
• Coma-like 3.22µm

• Postoperative Videokeratography 1 month
• OD
• K max 49.31 D.
• K min 47.39 D.
• Avg. K 48.35 D.
• Coma-like 3.66µm

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CLINICAL CASE

• Clinical Picture
• Left eye developed infectious keratitis 6 weeks
  after implantation
• Uncorrectable VA 0.05

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CLINICAL CASE

• Clinical Picture
• Visual acuity, as well as corneal clarity were
  restored after fortified antibiotics (Vancomycin)
  and corticosteroids (Dexamethasone) topical
  administration 6 times daily for 2 weeks.
• UCVA 0.5
• BSCVA 0.6 with 0.00 D/ -2.00D axis 110.

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CLINICAL CASE

• Clinical Picture
• Exacerbation of the infection with tapering of
  the antibiotic corticosteroids combination
  occurred due to traces of infectious pockets.

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CLINICAL CASE

• Clinical Picture
• One month after lower segment explantation
  corneal clarity was restored with mild stromal
  opacification corresponding to the infectious
  site.
• UCVA 0.1
• BSCVA 0.4
• -12.00 D/ -1.50D axis 140.

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CLINICAL CASE

• Postoperative data 7 months
• 4 months after explantation of the lower
  temporal segment of the left eye
• UCVA
• OD 0.4
• OS 0.1
• BSCVA
• OD 0.7 with -5.00 D/ -2.00 D axis 050.
• OS 0.4 with -11.00 D/ -2.00 D axis 100.

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CLINICAL CASE

• OS
• K max 51.68 D.
• K min 48.05 D.
• Avg. K 48.73 D.
• Coma-like 5.50µm

• Postoperative Videokeratography 7 months
• OD
• K max 48.60 D.
• K min 45.60 D.
• Avg. K 46.75 D.
• Coma-like 3.18µm

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CONCLUSION

• Intrastromal corneal ring segments KERARING
  are an effective, as well as a reversible
  procedure for keratoconus correction.
• In spite of utilizing advanced technology
  femtosecond laser the risk of complication
  infectious keratitis still exists.
• With incision on Steepest axis the relatively
  lower segment is more effective in correcting
  keratoconus.

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• Thank you