The document discusses the use of intracorneal ring segments for treating keratoconus, detailing the advantages of femtosecond laser tunnel creation for ring implantation. It presents various patient cases, highlighting factors influencing treatment outcomes and emphasizes that while rings can improve visual acuity, they are not a definitive solution and follow-up care is essential. Overall, the document outlines the complexity of managing keratoconus and the potential need for combined treatment approaches, including keratoplasty.

1. Intracorneal Ring Segments By
Femtosecond Tunnel Creation
BY
Dr. Amr Mounir
Lecturer of ophthalmology
Sohag university

2. Keratoconus is a
progressive,
noninflammatory,
bilateral (but usually
asymmetric) ectatic
corneal disease.
Introduction

3. Treatment modalities
include hard contact
lens, corneal collagen
crosslinking,
Intracorneal ring
segments and
Keratoplasty

4. Intracorneal Rings

6. Mechanism of action of rings

7. Types of Rings

8. Methods of implantation of rings

9. - Precise Depth
- Precise Incision site creation
- Easier than manual
- Avoid complications of manual tunnel creation e,g:
Anterior or Posterior corneal perforations ,
epithelial defects, infectious keratitis, asymmetric
segment placement, corneal stromal oedema
around the incision, extension of the incision
towards the central visual axis or the limbus and
persistent incisional gapping
Advantages of Femtosecond Tunnel
Creation

10. High errors.
Mean Keratometry > 48 Ds
K Max > 50 Ds
BCVA < 6/30
High patient motivation
Ideal patient for rings

11. Our provisional Experience
in Sohag

12. Rings we use

13. Parameters which guide us
- Refraction
- Pachymetry
- Steepest K axis
- Cone site
- Nomogram

14. Non central cones.
High cylinder.
High difference between K1, K2.
Thickness at insertion site >400 um
Kerarings

15. Non of treatment options is satisfactory for the patient.
The disease is progressive by its nature.
Follow up is mandatory.
Combination of treatment options can be done.
Keratoplasty can be a final destiny even with treatment.
Rings mostly will be followed by glasses.
Don't judge on improvement of VA without correction.
Financial aspect should be taken into consideration.
Rings results are unpredictable
Rules in treatment by rings

16. Nomogram for Kerarings

21. Tunnel creation by Femtosecond laser

22. Kerarings Ring implantation

23. Pre and post Kerarings Pentacam

24. About 250 eyes
had been
operated with
Keraringes
implantation by
Intralase
technology
Our provisional
experience in Sohag
Femtocenter

25. We ask ourselves very important
question

26. What are factors that affect
the results of ring
implantation ????

27. Age as a guideline

28. A 23 ys female with bil. Keratoconus Rt. Eye is advanced
more than Lt. eye.
Preoperative refraction of Rt. eye : -6.00 Ds -3.50 Dc
UNCVA : 4/60
BCVA : 6/30

30. Postoperative refraction of Rt. eye : -2.50
Ds -1.50 Dc
UNCVA : 6/30
BCVA : 6/18

32. Symmetry of Bowtie as a guideline

33. A 37 ys male with bil. Keratoconus Rt. Eye is
advanced more than Lt. eye.
Preoperative refraction of Rt. eye : -4.25 Ds
-7.00 Dc
UNCVA : 3/60
BCVA : 6/38

35. Postoperative refraction of Rt. eye : +1.00
Ds -1.0 Dc
UNCVA : 6/38
BCVA : 6/18

38. Corneal thickness as a guideline

39. A 17 ys male with RT. Advanced Keratoconus .
with thinnest location 348 um with max k: 60 D
Preoperative refraction of Rt. eye : -15.00 Ds
-8.00 Dc
UNCVA : 2/60
BCVA : 6/60

41. Postoperative refraction of Rt. eye
: -7.50 Ds – 5.00 Dc
UNCVA : 6/60
BCVA : 6/30

43. Rings in advanced cases

44. To delay corneal grafting.
To make the eye refractable.
To decrease coma aberrations.
N.B: Keratoplasty is still an option
Aim:

49. Thank you