Topography-Guided Photorefractive Keratectomy After Intacs Corneal Implantation for Keratoconus and Ectasia

Abstract

Purpose: To evaluate outcomes of topography-guided photorefractive keratectomy (TG-PRK) after Intacs (Addition Technology) implantation for eyes with keratoconus or ectasia. Methods: Three eyes of 3 patients with keratoconus or ectasia after laser in situ keratomileusis were treated with TG-PRK 6 months after simultaneous Intacs implantation and standard corneal cross-linking (CXL) was performed. Results: After Intacs implantation/CXL, uncorrected distance visual acuity improved four lines in 1 eye and did not change significantly in the other eyes. At 1 year of follow-up after TG-PRK, uncorrected distance visual acuity further improved more than two lines in all eyes. After Intacs implantation/CXL, corrected distance visual acuity did not change significantly in all eyes. One year after TG-PRK, corrected distance visual acuity improved more than two lines in all eyes. After both procedures, the inferior-superior value decreased and maximum keratometry flattened significantly in all eyes. The change in thinnest pachymetry was less than 32 µm. Conclusions: TG-PRK appears promising as a treatment modality to improve visual acuity and corneal topography in patients with keratoconus and ectasia with prior Intacs placement who may have previously required segment explantation after poor refractive outcomes. [ Journal of Refractive Surgery Case Reports. 2023;3(2):e10–e13.]