Reduced best spectacle-corrected visual acuity from inserting a thicker Intacs above and thinner Intacs below in keratoconus.

PURPOSE: To report a case of decreased best spectacle-corrected visual acuity (BSCVA) 2 months after Intacs implantation.

METHODS

A 33-year-old woman with keratoconus and contact lens intolerance underwent Intacs surgery in the left eye at another institution. Two segments were used--a thinner one (0.25 mm) below the cone and a thicker one (0.35 mm) above the cone.

RESULTS

Two months postoperatively, the patient presented to our practice with BSCVA reduced from 20/20 to 20/30. The superior Intacs segment was explanted, the inferior segment was exchanged for a thicker one (0.35 mm), and collagen cross-linking with riboflavin treatment was performed. This resulted in visual, topographic, and refractive improvement with BSCVA returning to 20/20.

CONCLUSIONS

Single inferior segment Intacs may be more appropriate for paracentral and peripheral cones. Collagen cross-linking may help cause further flattening. Using asymmetrical segments, with the thicker segment above the cone, may increase distortions and result in loss of BSCVA.