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Complications of intracorneal ring segment implantation in the treatment of keratoconus: a comparative study between manual and femtosecond laser-assisted surgery

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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: 08:54

Venue: Room A4

First Author: : T.Fernandes PORTUGAL

Co Author(s): :    T. Monteiro   N. Franqueira   F. Faria Correia   F. Vaz           

Abstract Details


To investigate and compare the incidence of complications between manual and femtosecond-laser assisted surgery and its relation with the disease characteristics before surgical intervention; as well as the final result after its resolution.


This is a retrospective multicenter study that included patients with keratoconus that had ICRS implantation at the Ophthalmology Department of Hospital de Braga, Portugal (manual surgery) and the Ophthalmology Department of Hospital CUF, Porto, Portugal (femtosecond laser surgery) between 2011 and 2017 and a minimum follow-up of 12 months.


All eyes included fulfilled classic clinical, slit-lamp and topography findings confirming the diagnosis of keratoconus. Topography was provided by a rotating camera Scheimpflug system (Pentacam, Oculus Optikgeräte GmbH, Wetzlar, Germany). All eyes in the study received the Keraring SI 5 and SI6 ICRS (Mediphacos Inc., Belo Horizonte, Brazil) either by manual technique surgery or femtosecond laser assisted surgery. Patients were scheduled for postoperative clinical evaluation at 1 day, 1 week, and 1, 6 and 12 months. Complete ophthalmologic examination included manifest refraction,biomicroscopy,Goldmann applanation tonometry, binocular indirect ophthalmoscopy, corneal topography, corneal aberrometry, UDVA, and CDVA, was performed at follow-up visits.


The study included 376 eyes of 376 patients; 265 in the manual group and 111 in the femtosecond laser group; In the manual group we observed a rate of 18.11% complications and in the femtosecond laser 3.6% complications. In the manual group, the most frequent complications described were ICRS exchange/adjustment for visual and refractive enhancement (25 eyes; 9.43%) and late ICRS spontaneous extrusion (15 eyes; 5.66%). With femtosecond laser surgery we had one case of corneal intraoperative perforation; two case of ICRS exchange, and one case of corneal infection (which was the same eye of one of the ICRS exchange).


Visual, refractive and topographic results are similar between techniques; however, the incidence of complications was significantly higher in the manual group (18.11% vs 3.98%). All the major complications observed; namely corneal perforation, ICRS extrusion or improper ICRS implantation can be overcome with a subsequent procedure, allowing a significant improvement in visual acuity, refraction and topographic indices. No association was found between the occurrence of complications and lower pachymetric values, younger age or higher maximum or mean corneal curvatures.

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