Ocular involvement in anti-epiligrin cicatricial pemphigoid.

PURPOSE: To report an anti-epiligrin cicatricial pemphigoid (AECP) patient with severe ocular involvement and to provide a practical approach to distinguishing AECP patients from those with other subepidermal blistering diseases. METHODS: Techniques included direct and indirect immunofluorescence microscopy, Western blot and immunoprecipitation studies, as well as interdisciplinary examinations of mucous membranes and skin. RESULTS: This study describes a patient with clinical features of cicatricial pemphigoid, circulating anti-basement membrane zone IgG antibodies, and subepidermal blisters. Histopathology and immunofluorescence analysis suggested the diagnosis of a cicatricial pemphigoid-like type of epidermolysis bullosa acquisita. However, Western blot and immunoprecipitation studies demonstrated that the patient's serum contained autoantibodies against laminin 5 alpha3 subunit, leading to the diagnosis of an AECP. CONCLUSION: Since patients with AECP have an increased relative risk for malignant tumors, it is important to distinguish this entity within the spectrum of cicatricial pemphigoid patients by additional studies such as Western blot or immunoprecipitation.

Goldmann applanation tonometry after intacs corneal ring segments(1).

PURPOSE: To evaluate the change of intraocular pressure (IOP) after implantation of Intacs (KeraVision) corneal ring segments using Goldmann applanation tonometry (GAT). SETTING: Multicenter clinical trial for U.S. Food and Drug Administration application conducted at 10 U.S. sites. METHODS: One-year follow-up data from a phase III clinical trial (n = 359) were reviewed. Intraocular pressure was measured by GAT preoperatively and 1 week and 1, 3, 6, and 12 months after Intacs implantation. The untreated fellow eyes were controls. Change from baseline (preoperative) IOP was calculated and tested for correlation with age and change from baseline in mean keratometry, manifest refraction spherical equivalent (MRSE), and pachymetry (central corneal thickness). Mean IOP in treated and control groups was compared through month 6. RESULTS: At all postoperative examinations, mean IOP in the Intacs eyes was significantly lower (-0.39 to -1.75 mm Hg; all P

Clinical characteristics of lamellar channel deposits after implantation of intacs.

PURPOSE: To report the frequency, location, and severity of biomicroscopically evident intrastromal deposits that may accumulate in the lamellar channel after implantation of Intacs corneal ring segments. SETTING: United States Food and Drug Administration multicenter clinical trial conducted at 10 sites. METHODS: Two-year follow-up data from a phase III clinical trial (N = 359) were reviewed. Examiners at 10 study sites described the location and severity (density) of deposits, grading severity on a standardized scale from absent (0) to severe (4). At 24 months, the incidence of deposits was 74% overall and 61%, 73%, and 89% with the 0.25, 0.30, and 0.35 mm Intacs, respectively (P <.001). The incidence increased sharply at first and more slowly after 6 months. RESULTS: At 12 months, deposits were located along the inner curvature of the segments in 47% of patients, along the outer curvature in 5%, along both inner and outer curvatures in 38%, and anterior to the segments in 10%. The severity of the deposits increased with segment thickness (P <.001 at 6, 12, and 24 months). CONCLUSIONS: Lamellar channel deposits occurred frequently after Intacs implantation. The incidence and density of deposits increased with segment thickness and duration of implantation. The presence of this material did not result in alteration of the optical performance of Intacs or anatomical or physiological corneal deterioration.

Surgically induced astigmatism after implantation of intacs intrastromal corneal ring segments.

PURPOSE: To analyze surgically induced astigmatism (SIA) after implantation of Intacs intrastromal corneal ring segments. SETTING: Multicenter clinical trials in the United States. METHODS: Data from 11 investigational sites involved in the Phase II and III trials of Intacs for the United States Food and Drug Administration were retrospectively analyzed. The distribution of Intacs thicknesses implanted in 449 eyes was 0.25 mm in 148 eyes, 0.30 mm in 151 eyes, and 0.35 mm in 150 eyes. Refractive astigmatism was measured by subjective manifest refraction preoperatively and 1 week and 1, 2, 3, 6, 9, and 12 months postoperatively. The mean simple change in astigmatism and the surgically induced refractive change were determined by vector analysis. RESULTS: Mean induced astigmatism at 12 months was 0.13 diopter (D) +/- 0.52 (SD). Induced astigmatism was more frequently with the rule (44%) than against the rule (26%) or oblique (30%). Maximal mean astigmatism was 0.50 +/- 1.09 D and occurred at 7 days. Mean induced astigmatism increased with segment thickness (0.01 D, 0.17 D, and 0.21 D for the 0.25 mm, 0.30 mm, and 0.35 mm segments, respectively). Mean surgically induced refractive change in cylinder power in all eyes at 12 months by vector analysis was 0.17 D x 92. CONCLUSION: Mean SIA was not clinically meaningful 12 months after Intacs implantation.

One year results of European Multicenter Study of intrastromal corneal ring segments. Part 1: refractive outcomes.

PURPOSE: To assess the efficacy, predictability, stability, and safety of correcting myopia with intrastromal corneal ring segments (ICRS, KeraVision, Inc.). SETTING: Twelve European investigational sites. METHODS: Patients with myopia of -1.0 to -6.0 diopters (D) and best spectacle-corrected visual acuity (BSCVA) of 20/20 or better (except in 3 eyes) were assigned to receive 1 of 5 ICRS thicknesses (0.25, 0.30, 0.35, 0.40, or 0.45 mm). Efficacy was assessed by postoperative uncorrected visual acuity (UCVA), predictability of refractive outcome (deviation from predicted cycloplegic refraction spherical equivalent), and stability of refractive effect (manifest refraction spherical equivalent [MRSE]). Safety was assessed by maintenance or loss of preoperative BSCVA and induced manifest refraction cylinder. Measurements were made preoperatively and 1 and 7 days and 1, 2, 3, 6, and 12 months postoperatively. RESULTS: One hundred fifty-nine ICRSs were implanted in the eyes of 107 patients (52 patients had bilateral implantation). Preoperatively, UCVA was worse than 20/40 in 98% of eyes (155/159); 12 months postoperatively, it was 20/20 or better in 63% of eyes (83/132) and 20/40 or better in 96% (127/132). Predicted refractive corrections for each ICRS thickness generally correlated with achieved corrections. At 12 months postoperatively, 90% of eyes (124/138) were within +/-1.00 D of plano (MRSE). Two or more lines of BSCVA were lost in 6% of eyes (8/135); all 8 eyes had BSCVAs of 20/25 or better. CONCLUSION: The ICRS safely, effectively, and predictably reduced or eliminated low to moderate myopia. Refractive correction was stable through the 12 month follow-up.

One year results of European Multicenter Study of intrastromal corneal ring segments. Part 2: complications, visual symptoms, and patient satisfaction.

PURPOSE: To assess intraoperative and postoperative complications, visual symptoms, and patient satisfaction after implantation of intrastromal corneal ring segments (ICRS, KeraVision, Inc.) for the correction of myopia and to demonstrate the reversibility and adjustability of refractive corrections with this method. SETTING: Twelve European investigational sites. METHODS: Patients with myopia of -1.0 to -6.0 diopters (D) were assigned to receive 1 of 5 ICRS thicknesses (0.25, 0.30, 0.35, 0.40, or 0.45 mm). Complications and visual symptoms were noted, and patient satisfaction was assessed at each postoperative visit (1 and 7 days and 1, 2, 3, 6, and 12 months). Refractive data were assessed after removal or exchange of the ICRS. RESULTS: Of 163 eyes of 110 patients enrolled, 159 eyes of 107 patients were implanted with an ICRS (52 patients had bilateral implantation). Intraoperative complications occurred in 2% of eyes (4/163 eyes in 3 patients) that were withdrawn from the study: 3 eyes had anterior surface perforations and 1 had a posterior microperforation into the anterior chamber. Most patients had no visual symptoms at 12 months; symptoms usually occurred rarely or sometimes and were mild in severity. At 12 months, good or excellent patient satisfaction was reported for 94% of eyes. Twelve ICRSs (8%) were removed, mainly because of undercorrection and induced astigmatism, and 2 were exchanged. All eyes were within +/-1.00 D of the preoperative manifest refraction spherical equivalent. CONCLUSIONS: The ICRS was safe for correction of low to moderate myopia. Severe postoperative visual symptoms were rare, and patient satisfaction was high. The refractive correction was largely reversible.

Anterior chamber contamination during cataract surgery with intraocular lens implantation.

PURPOSE: To measure anterior chamber bacterial and fungal contamination at the beginning and end of cataract surgery with intraocular lens (IOL) implantation in a large series of patients and to determine the influence of preoperative treatment and operative technique on contamination. SETTING: Department of Ophthalmology, County Hospital of Salzburg, Austria. METHODS: This prospective study comprised 700 consecutive patients having planned cataract extraction (511 phacoemulsification, 189 extracapsular cataract extraction [ECCE]). Thirty-four patients required an anterior vitrectomy; 8 myopic patients did not receive an IOL. A preoperative smear and two intraoperative (at the beginning and end of surgery) anterior chamber aspirates were obtained from each patient. Postoperative smears were obtained at discharge. Three preoperative treatments were evaluated: no lacrimal system irrigation, no topical antibiotic (n = 282); lacrimal system irrigation with balanced saline solution, no topical antibiotic (n = 243); lacrimal system irrigation, antibiotic (neomycin) eyedrops (n = 175). All patients received topical indomethacin twice a day preoperatively. RESULTS: Preoperative conjunctival smears showed bacterial growth in 76.6% of eyes, with coagulase-negative staphylococci (75%) the most common bacteria. Anterior chamber aspirates were culture positive in 14.1% at the beginning and in 13.7% at the end of surgery, with coagulase-negative staphylococci and corynebacteria the most common. Contamination rates of conjunctival smears taken at discharge were significantly lower (35%) than those taken preoperatively. There was no statistically significantly higher risk of anterior chamber contamination in eyes having ECCE than in those having phacoemulsification. Preoperative treatment did not statistically significantly influence intraoperative aqueous humor contamination rates. There were no cases of acute postoperative endophthalmitis. CONCLUSION: Bacteria entered the anterior chamber during cataract extraction and remained there at the end of surgery in a significant percentage of patients. Surgical technique, preoperative antibiotics, and preoperative lacrimal system irrigation had no statistically significant effect on contamination.

Evaluation of donor tissue with a new videokeratoscope: the Keratron Scout.

PURPOSE: To evaluate the percentage of corneas with an epithelial surface quality sufficient for a reliable screening of donor eyes with keratoconus and after photorefractive keratectomy (PRK) or laser in situ keratomileusis (LASIK) treatment for refractive errors. The usefulness of the computer-assisted, video-keratography system Keratron Scout in making this determination was evaluated. METHODS: Forty eyes from 20 donors were screened within 30 minutes after enucleation and within 24 hours postmortem. At first a meticulous slit-lamp evaluation of the corneal surface and stroma was performed; thereafter eight pictures per eye were taken with the Keratron Scout, and an ultrasound pachymetry reading of the corneal center was taken. "True curvature," algorithm-based color maps were used for analysis. Epithelium was not removed, because all corneas were suitable for transplantation. Balanced salt solution was used to keep the corneas moist. The low intraocular pressure regularly found in postmortem eyes was raised to within normal ranges by intravitreal injection. Corneas were classified according to the integrity of their epithelial surface, which influences the regularity of the topography maps. RESULTS: The quality of the images acquired varied, depending mostly on the quality of the epithelium. Regular topography patterns were found in 15 eyes (37.5%); in 14 eyes (35%), minimal epithelial roughness or sloughing in just one quadrant of the cornea was detected. Moderate to severe epithelial irregularities or defects were found in nine eyes (22.5%). Screening for abnormal shape was possible in 90% of the tested eyes, where no changes caused by prior refractive surgery or keratoconus were apparent. CONCLUSION: The postmortem quality of the epithelial surface allows screening for keratoconus or refractive procedures in the majority of donor eyes. Video-keratography with the Keratron Scout seems to offer a sensitive and quick method for this purpose, thereby adding an additional safety feature to eye banking in view of the rapid development of corneal refractive surgery.

Recurrent keratoconus in a patient with Leber congenital amaurosis.

PURPOSE: Clinical history of a 17-year-old patient with Leber congenital amaurosis (LCA) with histologically proven recurrent keratoconus (KC) two years after corneal transplantation in one eye and a recurrence-like appearance with a more global contour on the other eye four years after corneal grafting is reported. The possible mechanisms for this recurrence are discussed in light of the fact that this is, to the best of our knowledge, the first penetrating keratoplasty reported in LCA. METHODS: Computerized videokeratography (CVKG) and specular microscopy were performed preoperatively. The patient underwent regrafting, and the excised corneal button was examined by light microscopy and transmission electron microscopy. RESULTS: Analysis of CVKG showed a keratoconus-like pattern on the right eye, with the left eye demonstrating the aspects usually seen in keratoglobus. Histologic examination revealed the features usually observed in progressed keratoconus. CONCLUSION: Recurrence of keratoconus in a graft has not yet been described after such a short time until now. A "true" recurrence of the disease is postulated; it could be caused by an "aggressive" genetic factor that also leads to the frequent KC in patients with LCA. This mechanism also could explain the high incidence and rapid progress of KC in this disease.

Eurosol versus fetal bovine serum-containing corneal storage medium.

PURPOSE: To evaluate the usability of Eurosol, a new medium-term corneal storage medium without components of bovine origin. METHODS: Ten pairs of human donor corneas were placed in tissue culture at 31 degrees C for 7, 14, 21, 28, or 35 days. One cornea of each pair was cultivated in conventional storage medium on Earls' minimum essential medium base containing 2% fetal bovine serum; the other one was stored in Eurosol. Corneas were examined with inverse light microscopy; corneal thickness was measured; and scanning electron microscopy was performed. RESULTS: No significant difference in corneal thickness and endothelial cell count was found at any time. Scanning electron microscopy showed a complete endothelial cell layer on all corneas. CONCLUSION. The findings indicate a potential clinical applicability of the tested serum-free medium-term storage medium, offering a safer alternative to conventional media containing fetal bovine serum.

Diode laser transscleral cyclophotocoagulation for refractory glaucoma.

PURPOSE: To evaluate the efficacy of contact diode laser transscleral cyclophotocoagulation using different treatment parameters. METHODS: All eyes undergoing contact diode laser transscleral cyclophotocoagulation between April 1991 and September 1997 at our two institutions were enrolled. Success was defined as an intraocular pressure less than or equal to 22 mm Hg or absence of pain for poorly sighted and blind eyes. RESULTS: Two hundred six eyes of 204 patients (Salzburg, 117 eyes; New York, 89 eyes) were enrolled. Mean patient age was 65.8 +/- 18.7 years (range, 4-96 years). Mean follow-up was 9.2 +/- 11.2 months (range, 3-56 months). Mean preoperative and postoperative IOPs were 42.1 +/- 11.0 mm Hg (range, 24-76 mm Hg) and 17.3 +/- 10.9 mm Hg (P < 0.001) and 20.3 +/- 13.2 mm Hg (P < 0.001) at 12 and 24 months, respectively. The number of laser applications (mean, 18.6 +/- 4.2; range, 10-40) and maximal laser power (mean, 2,352 +/- 408.5 mW; range, 1,500-3,000) were not associated with a lower postoperative IOP. An IOP less than or equal to 22 mm Hg was achieved in 72.7% of eyes at the mean follow-up of 9 months. Thirty-three (16.0%) eyes required at least one retreatment. Phthisis occurred in four (1.9%) eyes. CONCLUSION: Contact diode laser transscleral cyclophotocoagulation is useful in eyes with refractory glaucoma in which the risks of outflow surgery are deemed unacceptable.

[Amniotic membrane transplantation with limbal stem cell transplantation as a combined procedure for corneal surface reconstruction after severe thermal or chemical burns]. / Amnion-Limbus-Transplantation zur Oberflächenrekonstruktion nach schwerer Verätzung und Verbrennung.

BACKGROUND: Severe thermal and chemical burns may result in limbal deficiency leading to persistent epithelial defects, complete conjunctival epithelial ingrowth and vascularisation of the cornea. If sufficiently severe, these burns may lead to very significant visual impairment. Amniotic membrane transplantation with limbal transplantation has recently been proposed as a new method for corneal surface reconstruction. PATIENTS AND METHODS: A total of 14 patients (age 18-62 years, mean age 42 years) with limbal deficiency resulting from thermal ( n=1) or chemical burns ( n=13) underwent surgery. The corneal pannus was completely removed and the amniotic membrane was grafted onto the cornea. Limbal transplantation using autografts obtained from contralateral eyes was performed simultaneously in seven cases. Allografts from a donor were transplanted in seven cases with bilateral involvement. These patients received oral cyclosporin A postoperatively. The mean follow-up time was 18 months. RESULTS: In all cases of limbal autografts the corneal surface showed a complete and stable epithelialisation within a few weeks. Out of seven patients with limbal allografts three displayed recurrent epithelial defects in the long term. The initially semitransparent amniotic membrane became more translucent and biomicroscopically invisible within several months after surgery. There was an increase in visual acuity in most cases, limited mostly by irregular astigmatism due to the initial stromal loss. CONCLUSIONS: Amniotic membrane transplantation with limbal transplantation allows reconstruction ocular surfaces severely damaged by chemical or thermal burns. In most cases, however, additional surgical procedures such as lamellar or penetrating keratoplasty are required for adequate visual rehabilitation.

A comparison of visual acuity, predictability, and visual function outcomes after intracorneal ring segments and laser in situ keratomileusis.

PURPOSE: To compare correction of low myopia by intrastromal corneal ring segments (ICRS) and by laser in situ keratomileusis (LASIK) with respect to early visual recovery and refractive outcomes. METHODS: Eighty-two eyes implanted with ICRS in a phase III study for US Food and Drug Administration review were matched with 133 eyes treated with LASIK by criteria of age (> 18 years, < 65 years), preoperative myopia (-1.00 to -3.50 diopters [D]), astigmatism (< or = 1.00 D), single treatment, and attempted full correction. Examinations were performed preoperatively and postoperatively at days 1 and 7 and months 1 and 3. Visual acuity and manifest refraction data were collected retrospectively. Visual function scores were assigned, and summarized results were compared. RESULTS: Uncorrected visual acuity was 20/20 or better at day 1 in 24% of eyes (20/82) after ICRS and in 55% of eyes (73/133) after LASIK, and at month 3 in 75% of eyes (58/77) after ICRS and in 67% of eyes (84/126) after LASIK. Spherical equivalent refraction at month 3 was within +/- 1.00 D of intended correction in 99% of eyes (76/77) after ICRS and in 96% of eyes (121/126) after LASIK. Excellent visual function scores were noted at month 3 in 90% of eyes (69/77) after ICRS and in 78% of eyes (98/126) after LASIK. CONCLUSION: Patients treated with LASIK showed better uncorrected visual acuity immediately following surgery; however, beyond 1 month, patients treated with ICRS achieved better uncorrected visual acuity that continued to improve with time. Visual function scores indicate that ICRS eyes see at higher levels of uncorrected visual acuity than LASIK eyes do with the same refractive error. The ICRS and LASIK were comparable in the correction of mild myopia.

[Driving behavior of patients before cataract operation--is an unlimited driver's license justifiable? Results of an analysis of 1,124 patients of the ophthalmology department of a central hospital]. / Das Fahrverhalten von Patienten vor Operation des Grauen Stars--Ist der unbefristete Führerschein vertretbar? Ergebnis einer Analyse von 1124 Patienten der Augenabteilung eines Zentralkrankenhauses.

BACKGROUND: The aim of the study was to evaluate the driving habits and patterns of those patients, who underwent cataract-surgery during a one year period at the Landesaugenklinik Salzburg and to compare the preoperative visual acuity with the legal requirements in effect in Austria. MATERIALS AND METHODS: The best-corrected visual acuity prior to surgery and the individual driving customs were noted on a detailed questionnaire. RESULTS: A minimum of 5.6% of the overall number of patients with cataract (not taking visual field defects into account) were driving a motor vehicle with a visual acuity not sufficient to meet current legal requirements. Considering only those drivers licence holders that admitted to still driving a motor vehicle it can be concluded that 26% have a legally unsatisfactory visual acuity. As between 28,000 and 31,000 cataract-operations are performed yearly in Austria, this study seems to clearly indicate that at least 1,600 of these persons--regardless of an additional visual field defect--are illegally driving a motor vehicle. It can be additionally concluded that the number of undetected cases is significantly higher. CONCLUSIONS: It therefore seems appropriate to call for a mandatory eye exam by a qualified ophthalmologist of all persons holding a driving licence, possibly beginning at the age of 60. The license issued thereafter should be valid for an age-related period of time only.

[Intrastromal corneal ring segments (ICRS, Kera Vision Ring). One year outcome of the first 25 interventions]. / Intrastromale Corneale Ring Segmente (ICRS, Kera Vision Ring). Einjahresergebnisse der ersten 25 Eingriffe.

BACKGROUND: The advantages of the Intrastromal Corneal Ring Segments (ICRS) as compared to the frequently used methods for the correction of low to moderate myopia (RK, PRK, LASIK) are the intact optical zone and nearly complete reversibility. PATIENTS AND METHODS: Two ICR-Segments, made of PMMA (with an arc length of 150 degrees each) are placed in the deep stromal layers via a small radial incision. At the Landesaugenklinik Salzburg 25 continuous surgeries were performed as part of the European "MECCA-trial". RESULTS: Refractive results, intra- and postoperative complications with a follow-up of 12 months are presented. There was no visual loss after one year. In 40% (10/25) the best corrected visual acuity remained unchanged. In 56% (14/25) one line was gained, once two lines were gained. The spherical equivalent was slightly in the range of undercorrection--as wanted. The refractive astigmatism increased (0.5 dpt). The keratoscopy image showed positive aspheric appearance. CONCLUSION: The ICRS (Kera Vision Ring) seems to offer a precise and stable method to correct low myopia. The procedure is reversible to a large extent, potentially adjustable within certain limits and carries a minimal risk only. Although long-term follow-up is not available yet, initial results of the technique seem very promising.

Confocal microscopy after implantation of intrastromal corneal ring segments.

OBJECTIVE: Confocal in vivo real-time microscopy was used to study the corneal morphologic features in eyes after Intrastromal Corneal Ring Segments (ICRS; now called KeraVision INTACS, KeraVision, Inc., Fremont, CA) implantation. DESIGN: Noncomparative, interventional case series. PARTICIPANTS: The authors performed confocal real-time microscopy on a total of 21 eyes from 11 patients. Seventeen eyes from 10 patients (five female, five male; mean age 32.3 years; range 22-42 years) underwent uncomplicated ICRS surgery to correct myopia and were examined after surgery (average 8.6 months; range 2-15 months). Three patients had the ICRS implanted into only one eye, and those eyes were compared with the untreated fellow eyes. One eye of another patient was examined 1 and 6 months after ICRS removal. INTERVENTION: Flying slit-confocal microscopy was performed with water immersion objectives in the corneal center and near the nasal or temporal ICRS. Corneal optical sections were recorded in real time without further digital processing and were reviewed frame by frame. MAIN OUTCOME MEASURES: Video frames selected from all corneal layers were evaluated qualitatively and quantitatively. RESULTS: In the central cornea, we found normal morphologic features at all layers. In peripheral sections, epithelial cells with highly reflective nuclei in the basal cell layer were observed in six of 17 eyes (35%) implanted with ICRS. We found an intact corneal nerve plexus and undisturbed corneal endothelium immediately underneath the ICRS. Around the ICRS, moderate fibrosis was seen. In one eye, linear structures in bamboo-like orientation were detected after ICRS removal in the last keratocyte layer underneath the collapsed tunnel. CONCLUSIONS: Whereas the central corneal zone appears unchanged, the corneal stroma adjacent to the ICRS displays a slight, but distinct, activation of wound healing. Epithelial cells with highly reflective nuclei in this region may be an indicator for an increased biologic stress caused by the device.

[The intrastromal corneal ring (KeraVision Ring, ICR, ICRS). A modern method for correcting minor myopia]. / Der Intrastromale Corneale Ring (KeraVision Ring, ICR, ICRS). Eine moderne Methode zur Korrektur der geringen Myopie.

For the correction of low myopia several competing surgical methods have been developed over the last two decades: radial keratotomy (RK) and photorefractive keratectomy (PRK) are used clinically on a very large scale. Both techniques are basically irreversible. RK does structurally weaken the cornea and PRK has to be applied directly at the optical center. Both disadvantages can to a large extent be avoided by the recently introduced Intrastromal Corneal Ring (ICR) that is now implanted worldwide following a long experimental and clinical development phase. The device is manufactured from PMMA and is effective by volume addition in the corneal periphery, shortening of the central arc length and thereby flattening the central optical zone. The latest development uses two ICR-Segments (with an arc length of 150 degrees each) that are placed in the deep stromal layers via a small radial incision. The surgical details, refractive results and intra- and postoperative complications of both, several international studies (with up to 5 years of follow-up), and our own experiences (25 eyes, follow-up 9 months) are presented. The ICRS (KeraVision Ring) seems to offer a precise and stable method to correct low myopia. The procedure is reversible to a large extent, potentially adjustable within certain limits and carries a minimal risk only. A short comparison with RK and PRK is attempted. Although long-term follow-up is not available yet, initial results of the technique seem very promising.

[Intrastromal corneal ring segments (ICRS, KeraVision Ring, Intacs): clinical outcome after 2 years]. / Intrastromale Corneale Ringsegmente (ICRS, KeraVision Ring, Intacs): Klinische Ergebnisse nach 2 Jahren.

BACKGROUND: Since 1996 Intrastromal Corneal Ring Segments (Intacs, KeraVision, Inc., Fremont, CA, USA) have been used for the correction of mild to moderate myopia at the Salzburg Eye Clinic. Aim of this study was to evaluate the stability, reversibility and adjustability of this new method. PATIENTS AND METHODS: Our experiences and final results of 54 surgeries--30 eyes with a minimum follow-up of 2 years--, as well as the potential reversibility (3 explanations, 2 of them followed by PRK) and adjustability (3 exchanges) are reported in detail. RESULTS: None of the eyes lost more than one line in BSCVA (in 14 of 30 eyes the BSCVA improved, "Safety-Index": 1.13). 73% (22/30) reached an UCVA of 1.0 or better, 47% (14/30) of 1.25 or better ("Efficacy-Index": 0.79). After two years 47% (14/30) were within +/- 0.5 D of the attempted correction. We observed no significant intra- or postoperative complications. After ICRS removal the refractive data returned to within +/- 0.75 D (MRSE) and +/- 0.5 D (mean keratometry) of preoperative values, respectively. Patients with an ICRS exchange obtained an improved UCVA between 0.8 and 1.0, gaining between 2 to 4 lines. CONCLUSIONS: Within the follow-up period of 2 years the ICRS seem to provide a very stable correction of low to moderate myopia. The procedure is reversible to a large extent, potentially adjustable (within certain limits) and carries a minimal risk only. After explantation PRK can be performed with good visual results.