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Long-term safety, stability, outcomes, and implantation technique of more than two ICRS in one eye, or implantation of two adjacent rings of different diameters in the same side of the cornea, for the treatment of advanced keratoconus

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Session Details

Session Title: Primary and Secondary Ectasia

Session Date/Time: Sunday 23/09/2018 | 08:00-10:00

Paper Time: 08:36

Venue: Room A4

First Author: : I.Mokdad LEBANON

Co Author(s): :    W. Chanbour   E. Jarade                 

Abstract Details


To describe the insertion technique and evaluate the long term (up to 12 years) safety, stability and clinical outcomes of simultaneous (or sequential) implantation of more than 2 ICRS in the same cornea or 2 adjacent rings of different arc length and diameters using femtosecond laser for visual rehabilitation of advanced keratoconus with low CDVA


Beirut eye and ENT specialist hospital


In the simultaneous implantation technique, Intralase was used to create 2 concentric tunnels of different depth and diameters. Either 2 INTACS 150 segments were implanted in the outer tunnel and one KERARING 120 SI5 within the inner tunnel under the steep zone or one outer INTACS segment was implanted under the steep zone with 210 KERARING segment internal and co-centered to it. In the sequential technique, eyes that were implanted with 2 KERARING segments 160 SI5 with insufficient improvement of the CDVA were implanted with 2 outer INTACS rings using Intralase to create an outer tunnel concentric with the pre-existing.


9 eyes of 9 patients were treated with follow up ranging from 1 to 12 years (average 9 years). 7 eyes were treated simultaneously and 2 eyes sequentially. In the simultaneous group, 5 eyes were treated with 2 symmetrical INTACS segments and 1 KERARING 120 while 2 eyes were implanted with 1 outer INTACS segment and 1 inner KERARING 210. In the sequential group, 2 eyes previously implanted with KERARING 160 with insufficient improvement of CDVA were re-implanted with 2 INTACS segments. All eyes tolerated the procedures without complications. CDVA improved in all eyes (LogMAR:1 to LogMAR: 0.4)


Multiple ICRS insertion assisted by Intralase was well tolerated by the keratoconus corneas with marked improvement in visual acuity.

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