Combined ICRS insertion and LASIK to maximize postoperative residual bed thickness in high myopia

Abstract

Purpose: To describe a new technique and early outcomes of combined intrastromal corneal ring segment (ICRS) insertion and laser in situ keratomileusis (LASIK) to treat patients with moderate to high myopia and thin corneas. Setting: University-based academic practice, Boston, Massachusetts, USA. Methods: Combined ICRS insertion and LASIK was performed in 2 stages: ICRS channel formation (stage I) followed by LASIK and ICRS insertion (stage II). Results: Fifteen eyes of 11 patients with a mean preoperative spherical equivalent of −9.98 diopters (D) ± 2.60 (SD) (range −7.13 to −16.25 D) and mean preoperative astigmatism of 1.11 ± 0.75 D (range 0.00 to −3.00 D) were treated with combined ICRS insertion and LASIK. The mean central pachymetry was 526.13 ± 35.69 μm (472 to 579 μm). The uncorrected visual acuity was 20/40 or better in 7 of 15 eyes (46.67%) at 1 month, 6 of 12 eyes (50.00%) at 3 months, 5 of 12 eyes (41.67%) at 6 months, and 6 of 12 eyes (50.00%) at 12 months. The best spectacle-corrected visual acuity was 20/40 or better at all times. Postoperative maps confirmed the absence of ectasia. The postoperative spherical equivalent was within ±1.00 D of the intended refraction in 11 of 15 eyes (73.33%) at 1 month, 9 of 12 eyes at 3 and 6 months, and 8 of 12 eyes (66.67%) at 12 months. Conclusions: Results of combined ICRS insertion and LASIK in moderately to highly myopic patients with relatively thin corneas were good. Long-term studies are needed to determine whether this procedure will decrease the risk of LASIK-induced keratectasia in these patients.