Did you know that intracorneal ring segments can flatten the central corneal curvature by an average of 2.6 diopters? This method is a new way to correct vision. It has helped over 72.5% of patients with keratoconus, a condition that affects young people’s vision.
Intracorneal ring segments, also known as Ferrara rings or Intacs, are small, arc-shaped implants. They are made of inert plastic and are inserted into the cornea. This helps restore a regular shape and improves vision.
Key Takeaways
- Intracorneal ring segments can significantly flatten and regularise the central cornea, improving vision for about 2 out of 3 patients.
- Long-term studies have shown sustainable improvement in vision stability for over 5 years in 83.7% of keratoconus patients treated with Intacs.
- Intracorneal ring segments are a viable alternative to corneal transplantation for patients with moderate to advanced keratoconus.
- Femtosecond laser-assisted implantation of Intacs has a success rate of 84.7% for managing keratoconus.
- Intracorneal ring segments can also be effective in treating other corneal conditions, such as pellucid marginal degeneration and post-LASIK ectasia.
What is Keratoconus?
Keratoconus is a condition that changes the shape of the cornea, the clear front part of the eye. It makes the cornea bulge forward and become thinner. This leads to blurry and distorted vision.
This condition often starts in the teenage years and gets worse until the 30s. It’s a genetic condition, but only 10% of people with it have family members with it too.
This corneal abnormality can cause big vision problems in young people.
A Progressive Abnormality Affecting Corneal Shape
The cornea is the clear, dome-shaped front part of the eye. In keratoconus, it becomes thinner and more irregular. This makes it bulge outward like a cone.
This irregular shape distorts and blurs vision. It makes it hard to see clearly.
Causes Poor Vision in Young People
Keratoconus usually starts in the teenage years and gets worse until the 20s. It often stops getting worse in the 30s. This corneal abnormality can really affect the vision of young people.
It makes everyday tasks like reading, driving, and using digital devices hard.
“Keratoconus is a genetically determined condition, but only about 10% of people with the condition have another affected family member.”
| Statistic | Source |
|---|---|
| Keratoconus can be managed with contact lenses | Barnett and Mannis, 2011 |
| Microwave procedure followed by accelerated cross-linking showed promising outcomes for keratoconus treatment | Vega-Estrada et al., 2012 |
| Intracorneal rings have been effective in correcting keratoconus | Colin et al., 2000 |
| Collagen cross-linking has introduced a new treatment paradigm for corneal diseases, including keratoconus | Snibson, 2010 |
| Modified microkeratome-assisted lamellar keratoplasty has shown positive outcomes for keratoconus treatment | Busin et al., 2012 |
Intracorneal Ring Segments (ICRS)
Intracorneal Ring Segments (ICRS) are small, arc-shaped implants made of plastic. They are placed in the cornea during surgery. These corneal implants help correct the shape of the cornea in people with keratoconus.
Arc-Shaped Implants for Corneal Reshaping
The ICRS implantation takes about 30 minutes. It’s done as a day case under local anaesthetic. These implants aim to flatten and regularise the cornea, improving vision for many with keratoconus.
ICRS implants have become a key treatment for corneal diseases like keratoconus. Different types, such as Intacs and MyoRing, are available. Each has its own features and uses.
| ICRS Implant | Key Features |
|---|---|
| Intacs | Predicted myopic range of correction from -0.00 to -5.00 D and a predicted cylinder range of correction from +2.00 to +4.00 |
| Ferrara Rings | Available in European countries and South America, with different optical zones, internal and external diameters, and base thickness |
| KeraRings | Share similarities in design to Ferrara rings but offer different arc length options and are developed mainly for refractive correction in keratoconus |
| MyoRing | A continuous full-ring implant for myopia and keratoconus with a diameter range from 5–8 mm and thickness ranging from 200–320 microns |
Planning for ICRS implantation involves looking at refraction, keratometry, and corneal thickness. Implant makers provide guides for this. Many studies show the success of these corneal implants in treating keratoconus and other corneal issues.
Benefits of ICRS
Intracorneal Ring Segments (ICRS) are a game-changer for those with keratoconus. This eye condition makes the cornea irregular. The arc-shaped implants are placed in the cornea to flatten it, improving vision for many.
For about two out of three patients, their vision gets much better. This is thanks to the vision improvement brought by ICRS.
Flattening and Regularising the Central Cornea
ICRS work by spacing out the corneal fibres. This creates an arc effect that flattens the cornea. This reshaping can greatly improve vision for those with keratoconus.
Keratoconus can cause severe vision problems, especially in the young. The ICRS treatment can help correct this.
Improved Vision for Many Patients
Research shows ICRS can slow down keratoconus and improve vision. The treatment works well for many, with about two-thirds seeing a big improvement.
The choice of ICRS segments is based on specific guidelines. This ensures the best vision outcome for each patient.
“ICRS have been noted to flatten the central cornea, leading to improved keratometric readings, refraction, and vision in keratoconus patients.”
ICRS can change the cornea’s shape, addressing keratoconus. It’s a non-surgical option for many. This treatment could greatly enhance the lives of those with this condition.
Does ICRS Stabilise Corneal Shape?
The use of intracorneal ring segments (ICRS) has shown promising results in improving vision for those with keratoconus. This condition affects the cornea’s shape. The question is, does ICRS alone stabilise the cornea, or do more procedures follow?
Experts agree that ICRS often needs to be paired with corneal collagen cross-linking (CXL). This is especially true for younger patients. The combination of ICRS followed by CXL offers a more effective solution. It helps lock in the improved corneal shape and prevents keratoconus from getting worse.
For those in their mid-30s or older, CXL might not always be needed. In these cases, regular check-ups for about three years can confirm the cornea’s stability after ICRS.
Choosing to add CXL to ICRS depends on several factors. These include the patient’s age, the severity of keratoconus, and how well they respond to ICRS. An experienced ophthalmologist must evaluate each case to decide the best treatment plan.
“The combination of ICRS implantation and CXL has been shown to be an effective approach in stabilising the corneal shape and improving visual outcomes for patients with keratoconus.”
In summary, ICRS can greatly improve vision and partially stabilise the cornea. However, for long-term stability, especially in younger patients, CXL as a follow-up is often recommended. Regular checks are key to ensuring the treatment’s success and to catch any signs of keratoconus progression.
Who is Suitable for ICRS?
Intracorneal ring segments (ICRS) are recommended for those with keratoconus at a moderate to advanced stage. At an earlier stage, laser treatment and crosslinking are often preferred. But for those with vision worse than driving standard, ICRS is a good choice as a corneal transplant alternative.
ICRS Candidates
- Patients with moderate to advanced keratoconus
- Those who would otherwise need a corneal transplant to improve vision
- Individuals whose vision in glasses is already worse than the driving standard
Studies show ICRS can greatly improve vision, especially in advanced keratoconus. A study of 124 eyes saw a big jump in vision quality. The cornea flattened, astigmatism reduced, and aberrations like coma decreased.
“ICRS have shown safety concerns, such as segment extrusion, secondary bacterial keratitis, neovascularization, and migration. However, allogenic CAIRS (corneal allogenic intrastromal ring segments) and KeraNatural, a newer allogenic corneal inlay, have demonstrated positive results with fewer complications and higher safety.”
ICRS is a great corneal transplant alternative for ICRS candidates with keratoconus severity. It’s a less invasive way to improve vision and avoid more complex surgeries.
ICRS Implantation Procedure
The ICRS implantation is done as an outpatient procedure. It usually takes about 20 minutes. A femtosecond laser is used to make a small ring-shaped channel in the cornea. Then, the ICRS is placed in this channel with the help of an operating microscope.
The procedure uses local anaesthetic eye drops to keep the patient comfortable. After it’s done, patients often need a couple of days off work. This allows their eyes to heal and get used to the new ICRS implant.
Femtosecond Laser Application
The ICRS implantation starts with a femtosecond laser. This laser is very precise and uses laser technology. It helps create the ring-shaped channel in the cornea accurately and consistently.
ICRS Implantation under a Microscope
After the channel is made, the surgeon puts the ICRS in it under a microscope. This step needs a lot of skill from the surgeon. It ensures the ICRS is placed correctly in the cornea, improving the patient’s vision.
“The ICRS implantation procedure is a game-changer for individuals suffering from keratoconus, as it offers a safe and effective solution to improve their vision without the need for more invasive treatments.”
The ICRS procedure uses the femtosecond laser’s precision and the surgeon’s skill. It aims to flatten and regularise the cornea. This can improve the patient’s vision in about two-thirds of cases.
Risks and Side Effects
Intracorneal ring segment (ICRS) implantation can help those with keratoconus see better. But, it comes with risks and side effects. About 1 in 3 patients might not see as well as they hoped.
ICRS implantation can cause glare, halos, starbursts, and trouble driving at night. These problems usually get better over time. But, sometimes they don’t, and the ICRS might need to be removed or a transplant done.
Unsatisfactory Visual Outcomes
The aim of ICRS implantation is to make the cornea shape better. This should improve vision. But, it doesn’t work for everyone. The severity of keratoconus, the cornea’s shape, and the surgeon’s skill play a part.
Visual Symptoms and Side Effects
Even if vision improves, ICRS can cause glare, halos, and starbursts. These are more noticeable in the dark. They can really affect daily life, especially driving.
In rare cases, the ICRS might move out of place. This can cause more problems and might need more surgery. It’s important to see the eye doctor regularly to check on the implants.
Choosing to have ICRS implantation should be a careful decision. It’s important to talk to a qualified endodontist about the risks and benefits. This way, you can make sure it’s right for you.
INTRACORNEAL RING Implantation and Future Eye Care
If a patient gets a new eye problem later, like cataract or glaucoma, ICRS won’t stop them from getting good treatment. The implants are made from a special plastic called PMMA. They are meant to last forever but can be taken out if needed.
After 3 years of watching the cornea, it’s unlikely to get worse. Patients should still see their local optometrist every year. This helps catch any new eye issues early.
About 70% of people see their vision improve after ICRS surgery. The UK’s NICE approved it in 2007. The surgery is safe, with very few infections and rare need for more surgery.
FAQ
What is keratoconus?
Keratoconus is a condition where the cornea, the clear front of the eye, bulges and becomes thinner. This makes vision blurry and often starts in the teens. It gets worse until the 30s.
What are Intracorneal Ring Segments (ICRS)?
ICRS are small, arc-shaped implants made of plastic. They are placed in the cornea to correct its shape. This helps people with keratoconus see better.
How do ICRS improve vision?
ICRS flatten and shape the cornea, improving vision. About 2 out of 3 people see better after getting ICRS.
Do ICRS help stabilise the corneal shape?
It’s not clear if ICRS alone can stop the cornea from changing shape. Many doctors think adding corneal crosslinking (CXL) helps keep the shape better.
Who is suitable for ICRS?
ICRS are for those with moderate to advanced keratoconus. They might need a transplant otherwise. At an early stage, laser and crosslinking are often better.
How is the ICRS implantation procedure performed?
First, a femtosecond laser creates a ring channel in the cornea. Then, the ICRS is placed in it under a microscope. The whole thing is done with eye drops to numb the area.
What are the risks and side effects of ICRS?
The biggest risk is not seeing better, with 1 in 3 not feeling it helped. Common side effects include glare, halos, and trouble driving at night.
How does ICRS implantation affect future eye care?
ICRS won’t stop you from getting treatment for other eye problems later. After 3 years, the cornea is unlikely to get worse.
