Intacs for Keratoconus

Adopted from Dr. Soroudi’s Book: Advanced Refractive Surgery

Keratoconus is a relatively common eye condition that has been estimated to affect up to 1/2000 individuals worldwide. As its name implies, this condition refers to a “cone-shaped” cornea (kerato=cornea and conus=cone-shaped). As a result of this irregular shaped cornea, people with Keratoconus get “irregular” astigmatism, and can’t focus images with glasses or regular contact lenses.

Corneal Topographic Comparison

Regular Astigmatism (Normal Eye)                      Irregular Astigmatism (Keratoconic Eye)

Some patients with Keratoconus can enjoy functional vision with “Rigid Gas Permeable” (RGP) Contact Lenses, but either their vision deteriorates so much with time that these contact lenses either do not correct their vision enough, or their cornea is so irregular that these lenses no longer fit right and keep falling out.

To this day, most surgeons can only offer a corneal transplant for such patients, but there is a new FDA-approved procedure available for people with this condition (called intacs). This procedure will not only improve one’s uncorrected and best-corrected vision, but it helps stabilize the progression of this disease and help prevent the need for a transplant altogether. Further, it enables patients with Keratoconus to later undergo laser vision correction (with PRK) and help them see clearly with no glasses at all!

Intacs are tiny clear plastic inserts that are placed inside very small round tunnels that are made in the periphery of the cornea encircling the pupils.

There are two ways to open the tunnels where intacs are placed: just like with LASIK, one can use a special “prolate” mechanism to do it, or use the intralase laser, which makes these tunnels with air bubbles. The problem with the intralase technique is that it only makes tunnels up to 400um in depth, which in some patients may not be enough. The Prolate Mechanism allows us to make deeper tunnels, which in many patients translates into much better results.

The prolate system makes a thin tunnel inside the Cornea

Actual intacs rings

The intacs rings are gently placed inside the tunnel

The end result
(Dr. Soroudi’s Actual Patient)

With this quick & painless procedure, we have the ability to flatten the cornea considerably and treat myopes (those with near-sightedness) with extremely thin corneas or those with severe corneal ectasias (keratoconus, pellicuid marginal degeneration, or post-lasik ectasias) see much better without the need for a corneal transplant.

This procedure provides great hope for patients with Keratoconus, and can not only improve their vision without any correction, but can help them avoid a transplant surgery altogether. Dr. Soroudi is one of the leading, most experienced intacs surgeons in California, and he will discuss all your options with you during your consultation. If you are not a candidate for this procedure, Dr. Soroudi does offer corneal transplantation as an alternative.

There’s a lot of new press about a new technology called Collagen Cross Linking to treat people with Keratoconus (with and without intacs). Although the preliminary data appears to be promising, in Dr. Soroudi’s opinion, there just isn’t enough (long term) data to support this treatment for everyone. There are currently multiple ongoing studies to further evaluate this technology in the United States, and once this data becomes more statistically significant, and more long-term resulsts come to light, depending on the findings, Dr. Soroudi may incorporate this technology into his treatment regimen. Dr. Soroudi is considering becoming one of the investigators for this treatment for select patients, but for now, intacs with or without PRK provides great improvement for patients with even advanced Keratoconus.