INTACS Before or After Laser in situ Keratomileusis: Correction of Thin Corneas With Moderately High Myopia
PURPOSE: Intrastromal corneal ring segments (INTACS Micro-Thin Prescription Inserts by Addition Technologies, Fremont, Calif) were inserted as a combined surgery with laser in situ keratomileusis (LASIK) in six eyes with thin corneas to correct moderately high myopia.
METHODS: INTACS were implanted before LASIK (INTACS-LASIK) in three eyes and after LASIK (LASIK-INTACS) in three eyes. Mean preoperative manifest spherical equivalent refraction was -7.88 diopters. Mean follow-up was 306 days.
RESULTS: No intraoperative complications occurred. The LASIK-INTACS eyes were slightly more o ver corrected than the INTACS-LASIK eyes because of the enhanced performance of INTACS in the thinned corneal tissue. Induced astigmatism by INTACS per se was less in the LASIK-INTACS eyes than in the INTACS-LASIK eyes. At last examination, uncorrected visual acuity was better than 20/25 in all eyes. Best spectacle-corrected visual acuity was within 1 line of the preoperative value in all eyes.
CONCLUSION: Both methods resulted in significant improvement in visual acuity and refraction. Based on our limited experience, however, LASIK followed by INTACS is preferred for reasons of safety, convenience, and lower induced cylinder. [J Refract Surg 2004;20:818-822]
- 1. Knorz MC, Wiesinger B, Liermann A, Seiberth V, Liesenhoff H. Laser in situ keratomileusis for moderate and high myopia and myopic astigmatism. Ophthalmology 1998; 105:932-940. Google Scholar
- 2. Seiler T, Koufal K, Richter G. Iatrogenic keratectasia after laser in situ keratomileusis. J Refract Surg 1998; 14: 312-317. Google Scholar
- 3. Schanzlin DJ, Abbott RL, Asbell PA, Assil KK, Burris TE, Durrie DS, Pouraker BD, Lindstrom RL, McDonald JE 2nd, Verity SM, Waring GO 3rd. Two-year outcomes of intrastromal corneal ring segments for the correction of myopia. Ophthalmology 2001;108:1688-1694. Google Scholar
- 4. Fleming JP, Lovisolo CF. Intrastromal corneal ring segments in a patient with previous laser in situ keratomileusis. J Refract Surg 2000;16:365-367. Google Scholar
- 5. Siganos CS, Kymionis GD, Astyrakakis N, Pallikaris IG. Management of corneal ectasia after laser in situ keratomileusis with INTACS. J Refract Surg 2002;18:43-46. Google Scholar
- 6. Alio J, Salem T, Artola A, Osman A. Intracorneal rings to correct corneal ectasia after laser in situ keratomileusis. J Cataract Refract Surg 2002;28:1568-1574. Google Scholar
- 7. Lovisolo CF, Fleming JF. Intracorneal ring segments for iatrogenic keratectasia after laser in situ keratomileusis or photorefractive keratectomy. J Refract Surg 2002; 18: 535-541. Google Scholar
- 8. Shemesh G, Dotan G, Lipshitz I. Predictability of corneal flap thickness in laser in situ keratomileusis using three different micro keratomes. J Refract Surg 2002;18(suppl): S347-S351. Google Scholar
- 9. Colin J, Cochener B, Savary G, Malet F, Holmes-Higgin D. INTACS inserts for treating keratoconus: one-year results. Ophthalmology 2001;108:1409-1414. Google Scholar
- 10. Davis EA, Hardten DR, Lindstrom RL. Laser in situ keratomileusis after intracorneal rings. Report of 5 cases. J Cataract Refract Surg 2000;26:1733-1741. Google Scholar
- 11. Malecaze FJ, Hulin H, Bierer P, Fournie P, Grandjean H, Thalamas C, Guell JL. A randomized paired eye comparison of two techniques for treating moderately high myopia: LASIK and artisan phakic lens. Ophthalmology 2002;109:1622-1630. Google Scholar
- 12. Allemann N, Chamon W, Tanaka HM, Mori ES, Campos M, Schor P, Baikoff G. Myopic angle- supported intraocular lenses: two-year follow-up. Ophthalmology 2000;107:1549-1554. Google Scholar
- 13. Perez-Santonja JJ, Alio JL, Jimenez -Alfaro I, Zato MA. Surgical correction of severe myopia with an angle-supported phakic intraocular lens. J Cataract Refract Surg 2000;26:1288-1302. Google Scholar
- 14. Alio JL, de la Hoz F, Ruiz-Moreno JM, Salem TF. Cataract surgery in highly myopic eyes corrected by phakic anterior chamber angle-supported lenses. J Cataract Refract Surg 2000;26:1303-1311. Google Scholar
- 15. Uusitalo RJ, Aine E, Sen NH, Laatikainen L. Implantable contact lens for high myopia. J Cataract Refract Surg 2002;28:29-36. Google Scholar
- 16. Menezo JL, Peris -Martinez C, Cisneros A, Martinez-Costa R. Posterior chamber phakic intraocular lenses to correct high myopia: a comparative study between St aar and Adatomed models. J Refract Surg 2001;17:32-42. Google Scholar
- 17. Asbell PA, Ucakhan 00, Abbott RL, Assil KA, Burris TE, Durrie DS, Lindstrom RL, Schanzlin DJ, Verity SM, Waring GO 3rd. Intrastromal corneal ring segments: reversibility of refractive effect. J Refract Surg 2001;17:25-31. Google Scholar
- 18. Asbell PA, Ucakhan 00, Durrie DS, Lindstrom RL. Adjustability of refractive effect for corneal ring segments. J Refract Surg 1999;15:627-631. Google Scholar