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16.3 Case 3: INTACS
®
& crosslinking
by Prof. Renato Ambrósio Jr, Fernando Faria-Correia, MD,
Allan Luz, MD
A 24-year-old male patient presented with progressive keratoconus in OS and anisometropia.
Uncorrected visual acuity (UCVA) was 20/20 in OD and 20/200 in OS. Wavefront assisted manifest
refraction was sph -0.75 cyl -5.25 A 175°, giving 20/30 in OS. Femtosecond laser assisted (FS-200,
Alcon, Fort Worth) INTACS® implantation was performed using Keraring (Mediphacos, Belo Horizonte,
Brazil) SI6 150[o] with 250 mm thickness. INTACS® implantation was combined with transepithelial
(EpiON) crosslinking using riboflavin 0.22% solution (VibeX Xtra; Avedro Inc., Waltham, MS, USA).
The patient was subjected to 8 min. of pulsed UV-A light (1 sec on/1 sec off) at 30 mW/cm
2
(energy
dose of 7.2 J/cm
2
) with the Avedro KXL. After 6 weeks his UCVA was 20/30 and his BCVA was 20/25+
(sph 0.00 cyl -1.00 A 170°). Figure 150, documents the postoperative corneal flattening, along
with the increase in corneal density (optical scattering). Figure 151, Figure 152, show the INTACS®
position and demarcation line on the Scheimpflug image.
Figure 150: Preoperative, postoperative (6 weeks after femtosecond-assisted intracorneal
ring segment and transepithelial crosslinking) and subtraction maps of the
average optical density and axial curvature maps
16 INTACS
®
implantation
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