INTACS Surgery

Intacs is the trademark name for micro-thin prescription inserts. These were previously used as a form of refractive surgery in the treatment of low levels of myopia or nearsightedness. It has recently received FDA approval for keratoconus. Intacs corneal inserts or implants are a minimally invasive surgical option used basically for the treatment of keratoconus. Intacs are two tiny, clear crescent-shaped pieces of a plastic polymer that are inserted into the cornea to reshape the front surface of the eye.

In July 2004 the FDA granted Intacs a Humanitarian Device Exemption for use in the treatment of keratoconus largely because of Intacs' safety record as only a few treatment options, such as corneal transplants, were available for keratoconus. The approval allows Intacs to be marketed for reduction or elimination of myopia and astigmatism in keratoconus patients where functional vision is no longer obtained with contact lenses or eyeglasses.

The Function and Design of Intacs Corneal Inserts

The corneal implants are designed for long-term vision correction. For treating nearsightedness, Intacs correct vision by flattening the cornea to refocus light rays and improve vision. For keratoconus, Intacs work by flattening the steep part of the cornea or cone to reduce vision distortions. Intacs are made of the same biocompatible material found in intraocular lenses used for cataract surgery, so there is little or no risk of adverse effects from the material.

Results of these implants will depend on the degree of keratoconus in each individual. People with milder cases of keratoconus may not need any lenses for additional vision correction. People with moderate keratoconus may require glasses or soft contact lenses for improved vision.

Results and Vision Correction Options for Different Degrees of Keratoconus

Most published studies suggest that the best indications for INTACS are patients with mild to moderate keratoconus with a clear optical zone and who are contact lens intolerant. INTACS can then be offered as an alternative to penetrating or lamellar keratoplasty for visual rehabilitation. The upper limit of the steepest K reading should not exceed 58D, the patient should not have any scarring in the visual axis and the cornea should be at least 450um thick by ultrasonic pachymetry at the 7mm optical zone or over the area in which the INTACS are to be placed.

INTACS improves the best-corrected acuity by reducing higher order aberrations; they can be used to sphericize the cornea in patients who desire Phakic IOL’s to improve their uncorrected myopic refractive error or in patients with cataracts prior to their cataract surgery. Good outcomes have been reported when used in combination both with the Visian ICL and the Verisyse Phakic IOL.

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