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What is Intacs for Keratoconus?

Keratoconus is a condition in which the normal, clear, and dome-shaped cornea becomes thin and bulges outward to form a cone shape. The cornea plays an important role in refracting and focusing rays of light for clear vision; hence, an altered shape disrupts the function and distorts normal vision. Initially, keratoconus is treated with eyeglasses or contact lenses. However, since keratoconus is a degenerative disease, medical management with glasses or contact lenses eventually becomes insufficient, and a procedure is required to stabilize the deterioration of vision.

Intacs is an FDA-approved medical device used in the treatment of keratoconus. It is a set of tiny, clear plastic, crescent-shaped inserts or implants that are inserted into the cornea (clear layer of tissue over the front of the eye) to provide long-term vision correction in people who have keratoconus and who can no longer see properly with glasses or contact lenses. When they are placed into the eye, Intacs reshape the cornea by flattening it closer to its original dome shape, thereby reducing vision distortions and improving vision.

Indications for Intacs

Your physician may recommend Intacs to relieve symptoms of keratoconus and improve your quality of life. The signs and symptoms of keratoconus vary with the progression of the disease. Early symptoms include blurring of vision. Halos (rings seen around lights), night vision problems, and glare may develop over time. You may also experience sudden clouding of vision. 

Keratoconus is caused due to the weakening of collagen fibers, which is the tissue that holds the cornea in place. This results in the cornea gradually changing shape from round to cone-shaped. Intacs is used to normalize corneal shape as much as possible in order to improve vision with glasses or lenses. Intacs reshape the curvature of the cornea from within, enhancing the natural shape of your eye to correct mild near-sightedness and astigmatism, caused by an irregularly shaped cornea.

Preparation Involved with Intacs for Keratoconus

In general, pre-procedure preparation for Intacs placement includes:

  • A thorough preoperative eye examination to determine if your eyes are healthy and suitable for the procedure.
  • A variety of standard ophthalmic tests to determine if your eyes are healthy and suitable for the procedure.
  • Routine medical tests such as blood work and a review of your medical history.
  • Providing your physician with a list of medications and supplements you are taking
  • Adjusting the dose of medications you are on, or stopping certain medications, such as blood thinners or supplements such as Vitamin E and/or Fish Oil? Omega 3 for at least a week prior to surgery
  • Informing your doctor of any recent illnesses or other medical conditions you have, such as heart or kidney disease 
  • Refraining from eating or drinking at least 6 hours before the procedure. If you are on regular medication for conditions such as high blood pressure, diabetes, or heart disease, you may take it with a sip of water.
  • Arranging for someone to take you home after the procedure
  • Signing an informed consent form after the pros and cons of the procedure have been explained.

Procedure for Intacs Placement

Intacs placement procedure for keratoconus is usually performed in the procedure room at your doctor’s office. This procedure involves placing the Intacs plastic inserts just underneath the eye surface in the periphery of the cornea. In general, the procedure involves the following steps:

  • The surgery eye is cleaned and numbed with anesthetic eye drops.
  • An eyelid holder is placed over the eye to prevent the eye from blinking.
  • A single, small incision is made on the surface of the cornea. Instead of using mechanical cutting, some surgeons may use a laser to make the incision.
  • A centering guide is placed on the surface of the eye to help stabilize the eye and ensure proper alignment of the Intacs insert.
  • During this time, the corneal layers are gently separated in a narrow circular band on the outer edge where the Intacs will be placed.
  • Once the Intacs inserts are placed, the small opening in the cornea is closed with a suture or with tissue glue thereby making it sutureless.

Postoperative Care and Recovery

Your doctor will provide a series of postoperative instructions to be followed for a defined period. These include:

  • The use of steroid and antibiotic eye drops to minimize the risk of infection and inflammation
  • Wearing an eye shield to protect the eye and prevent rubbing it in your sleep
  • Taking time off work for a few days to rest the eye and promote healing
  • Avoiding sports activities or exercises that may stress the eye
  • Avoiding getting soap in your eye
  • Avoiding hot tubs or swimming
  • Avoiding cream, lotions, or make-up around the eye
  • Refraining from driving until your vision is restored
  • Wearing sunglasses to protect the eye outdoors
  • A follow-up visit will be scheduled to monitor your progress

Risks and Complications

The risks and complications of Intacs placement may include:

  • Eye infection
  • Blurry or fluctuating vision
  • Seeing "halos" or glare around lights
  • Difficulty with night vision
  • Eye irritation
  • Blepharitis (inflammation of the eyelids)
  • Neovascularization or abnormal growth of blood vessels in the cornea
  • Failure to produce a corrective effect or desired outcome