Challenging Cases With Keraring SI-6

1. TOTAL KERATOCONUS SOLUTION 2013
Keraring Global User Meeting
Challenging Cases With
Keraring SI-6
Nicolas Cesário Pereira
Hospital Oftalmológico de Sorocaba
Banco de Olhos de Sorocaba
nicolascepe@gmail.com

2. Diferences Keraring
SI-5 and SI-6

3. Keraring SI-6
Indications
Mesopic Pupil diameter > 5mm
Low paquimetry in 5mm optical zone to implant SI-5
Periferic ectasias (PMD and post LASIK)
Plan of a secundary refractive procedure
(PRK and/or phakic IOL)

4. Keraring SI-6
Surgical Plan
Use same nomogram as SI-5
Add 50μm to the selected segments?
If the selected arch length is 160, substitute for 150

5. Keraring SI-6
Surgical Technique
Manual: Use 6mm marquers and tunelizers
Femtosecond laser: Channel diameter 5,8 and
7,0

6. Case 1
Keratoconus with low corrected VA and CL intolerant OS
VA n/c OS CF 2m
OS -5,75 -0,50 150 20/60-2
SI6 90/250
SI6 150/300

7. VA n/c OS 20/30
Rx OS -1,75 -1,50 180 20/20

8. Case 2:
GAC, 46y
Keratoconus
ICRS OD 3y; PK OS 5y
Low VA and halos OD
OD AV s/c 20/160 and CL intolerant
Rx OD +0,50 -3,50 120
20/50p

9. Case 2:
Plan: Explant segments OD e reprogram
implant after 3 months

10. Case 2:
PO
VA n/c 20/30
Rx +0,50 -1,00 a 90 20/20p
Implant SI-6 150/250

11. Case 3
SKF, 41y
LASIK 9y
Low corrected VA OU
CL intolerant OU
SI6 - 150/250

12. VA OD n/c 20/60
0,00 -3,50 a 110 20/30p
SI6 - 150/200

13. PO
VA n/c 20/20
0,00 - 1,00 10 20/15p

14. VA OS n/c 20/160
-0,50 -5,50 110 20/40p
SI6 - 150/250

15. PO
VA n/c 20/15
plano 20/15

16. Case 4
AOC, 82y
Low VA AO 5y
No other comorbity
SI6 - 150/250

17. Case 4
OD
OS
Periferic Marginal Degeneration (Senile)
Cataract +/IV
SI6 - 150/250

18. Case 4
OD
VA OD n/c 20/200
+4,75 -3,25 a 70 20/40p
SI6 - 150/250

19. Case 4
OS
VA n/c 20/400
+6.25 -8.00 a 95 20/120
SI6 90/200
SI6 150/250
SI6 - 150/250

20. Case 4
OS
VA n/c 20/40
+2.50 -0.50 a 95 20/30
SI6 - 150/250

21. Case 4
Cataract surgery 3 months later
VA n/c OD 20/40
OS 20/25
OD +0.50 -2.50 a 70 20/20p
OS +0.75 -0.75 a 95 20/20
SI6 - 150/250

22. Keraring SI-6
Good previsibility - similar to SI-5
Less central flattening; good regularization
Less halos e glare – Mesopic pupils > 5mm
Plan of a secundary refractive procedure
(PRK and/or phakic IOL)
ICRS surgery is ajustable
Good results in challenging cases

23. Thank You!
nicolascepe@gmail.com