Inimaginável há poucos anos, a associação de segmentos concêntricos adjuvantes no tratamento da miopia e ceratocone tem trazido resultados praticamente refrativo no tratamento de pacientes com alta miopia e astigmatismo. A associação de segmentos de 5mm e 6mm se faz possível pela alta qualidade e precisão dos Tomógrafos e Laser de Femtosegundo que tornam a cirurgia extremamente precisa e os resultados reprodutíveis e passíveis de reintervenção e adequação do planejamento inicial.

1. LEONARDO TORQUETTI, MD, PHD
DOUBLE ICRS : A NEW APPROACH TO FINE TUNE
CLINICAL OUTCOMES
CENTRO DE EXCELÊNCIA EM OFTALMOLOGIA
PARÁ DE MINAS - MG - BRAZIL
WWW.CEOCLINICA.MED.BR

2. FINANCIAL DISCLOSURE
Consultant for:
- AJL - Spain;
- Ferrara Ophthalmics - Brazil;
- Mediworks - China;
- Johnson & Johnson - USA

3. DOUBLE ICRS
- ICRS are commonly used as a single ou paired
segments (at the same OZ);
- Clinical outcomes: not always as expected;
- New ICRS designs;
- New ICRS combinations;
Double ICRS

4. WHY DO WE NEED A NEW ICRS APPROACH?
- Patients seeking for refractive surgery with diagnosis of
keratoconus on the preoperative workup;
- Stable keratoconus patients that desires less
dependency on glasses / contact lenses;
- Keratoconus patients with indication for ICRS
implantation, having moderate astigmatism and
myopia.
Double ICRS

5. DOUBLE ICRS
Cross Section: ellipsoid
320 arch length
6 mm OZ
400 micra
Ferrara HM (High Myopia) 140-ICRS
Cross Section: triangular
140 arch length
5 mm OZ
150 to 250 micra

6. DOUBLE ICRS

7. MYOPIA BOOM

8. - 1 or 2 segments 140 + ICRS HM;
- 1 or 2 segments 160 + ICRS HM;
DOUBLE ICRS
Possible Combinations

9. DOUBLE ICRS
Q K Cyl
140 (arc)
160 (arc)
210 (arc)

10. FERRARA HM
Sample = 25 eyes of 21 patients (HM-ICRS followed by 140-ICRS);
Follow-up = 11.4 months (± 2.2);
Age = 27.4 (±6.8) (18 to 43 yo);
Surgical Technique = Femtosecond laser (Ziemer Z6) - HM
Laser (Manual) – 140-ICRS (60 days after)
STUDY IN BRAZIL
Sandro Coscarelli, Leonardo Torquetti
DOUBLE ICRS

11. Pre ICRS HM Post ICRS HM Post 140-ICRS Last follow-up
SPH -5,34 ± 2,74 -2,06 ± 1,84 -0,59 ± 1,54 -0,72 ± 0,60 45,51 <0,001
AST -3,72 ± 1,56 -2,82 ± 1,08 -1,37 ± 0,67 -1,53 ± 0,77 25,72 0,001
CDVA 0,48 ± 0,20 0,49 ± 0,20 0,57 ± 0,20 39,38 ± 12,66 24,17 <0,01
K1 46,10 ± 3,93 44,59 ± 2,98 42,83 ± 3,59 43,74 ± 3,37 29,21 0,007
K2 48,97 ± 4,56 46,54 ± 3,34 44,63 ± 3,73 45,40 ± 4,00 11,27 0,012
KM 47,08 ± 4,16 45,54 ± 3,10 43,72 ± 3,64 44,54 ± 3,61 11,73 0,008
Q -0,72 ± 0,29 -0,19 ± 0,55 0,25 ± 0,71 -0,01 ± 0,98 19,50 <0,001
SE -7,20 ± 3,13 -3,47 ± 1,93 -1,27 ± 1,53 -1,49 ± 0,75 23,53 <0,001
DOUBLE ICRS

12. DOUBLE ICRS
VA improvement after 2 ICRS implantation

13. DOUBLE ICRS
23-year-old male patient presented anisometropia and contact lens intolerance.
PREOP
-5,00 -7,00 x 170 20/80
POST HM-ICRS
-3,00 -4,00 x 180 20/80
POST 140-ICRS
-1,00 -2,00 x 10 20/30

14. DOUBLE ICRS
PREOP
-5,00 -3,00 x 130 20/25
35-year-old, female, candidate for refractive surgery presenting myopia and astigmatism both eyes.
Preop workup: mild keratoconus, contraindicated to Excimer laser.

15. DOUBLE ICRS
PREOP
-5,00 -3,00 x 130 20/25
POST HM-ICRS
-1,50 -3,00 x 120 20/25
POST 140-ICRS
-0,75 -1,25 x 115 20/25
35 year old, female, candidate for refractive surgery presenting myopia and astigmatism both eyes.
Preop workup: mild keratoconus, contraindicated to Excimer laser.

16. DOUBLE ICRS
PRE
-6,00-6,50 x 140 20/50
POST 140
-4,50 -1,00 x 120 20/40
POST HM
-1,50-1,50 x 120 20/30
FOLLOW UP
-1,25-2,00 x 180 20/30

17. DOUBLE ICRS
PRE
-5,00-2,50 x 105 20/80
POST HM
-2,00 -1,00 x 15 20/60
POST 140
-0,50 x 180 20/40
FOLLOW UP
-0,50 x 180 20/40

18. DOUBLE ICRS
PRE
-4,00 -0,50 x 85 20/20
DKS
PRE
RE -4,00 -0,50 x 85 20/20
28-year-old female patient, candidate for refractive surgery, with mild keratoconus.

19. DOUBLE ICRS
PREOP
-4,00 -0,50 x 85 20/20
POST HM
-1,00 -1,00 x 45 20/20
POST 140
0,25 -0,75 x 110 20/20

20. DOUBLE ICRS

21. KEY POINTS
- Indication and patient selection;
- Which ICRS first ? (140 or HM);
- HM: Always femto, subsequent 140-ICRS: manual or femto;
- Halos: uncommon.
DOUBLE ICRS

22. - The association of ICRS effectively reduces the SE and
improves UDVA and CDVA
- Safe;
- Tissue-saving procedure (high myopia + thin cornea);
- Myopia and astigmatism correction in keratoconus or
suspects.
DOUBLE ICRS

23. THANK YOU !
leonardo@ceoclinica.med.br