Intacs

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Intacs

Postby GarethB » Thu Nov 30, 2006 9:33 pm

These are the notes I took at the Birmingham support group meeting on Saturday 25th November 2006. The presentation was given by Vijay Savant, Corneal Fellow at the Eye Centre.

Intacs

First used in 1997 to treat myopia minus 1 to minus 5 dioptres (D) and astigmatism 10 D. Intacs are semi-circles of plastic inserted into the cornea.

The Intacs consist of 2 semi circular arcs made from PMMA (Poly(methyl methacrylate) stitched in for easy removal.


Indications for Intacs Use
Poor functional vision with contact lenses or glasses
Contact lens intolerance
Transplant is the only option left
Must have a clear central cornea.

Not all patients are suitable, as other conditions must be taken into account (see Contraindications). Intacs is only suitable for mild cases of Keratoconus because the corneal thickness is very important.


Contraindications
Corneas steeper than 46 D or flatter than 40D
Corneas less than 450 micrometers thick
Corneal diameters less than 10 nanometers and those with a high-dilated pupils size


How Do Intacs Work?
Intacs basically pulls the KC bulge in, i.e. the arc length is changed from a steep pointed angle to a shallower one, more like a gentle arc. To identify where to place the intac to reduce this arc steepness topography is done to identify the steep axis.


How Is the Intac Put In Place?
Under a general anaesthetic (sometimes done using a local anaesthetic) the eye is held in place using a strong vacuum. The centre and outer edge of the cornea is marked using a special centering stamp so the surgeon can identify from the topography where the incision is to be made and the intacs inserted. Using a diamond tipped blade a small incision is made into the cornea at the desired depth. Using the centering tool used to mark the eye, a cutter is located above the incision and the blade inserted and rotated 180 degrees. This separated the corneal layer forming a tunnel for the intac to be inserted. The tool is removed and replaced with another one that is used to make the tunnel on the opposite side. The intacs are then inserted into the tunnels and the incision closed with a single stitch.

The whole process takes about 30 minutes.


Recovery/Side Effects
Photosensitivity (1 to 1.3% of patients)
Fluctuations in vision
Foreign body sensation like something is stuck in the eye.

Vision takes time to settle, in the region of 6 to 12 months. Innitially vision can be worse, but at the healing process continues and settles, after 6 to 12 months it has usually improved. Once at least two consecutive stable topography and visual acuity readings are obtained the sight is corrected with glasses or contact lenses. Vision can be corrected sooner if the patient is willing to pay for regular prescription changes.

The intacs procedure is reversible and means should the KC progress, a graft can still be carried out although modern views are that grafts have a 10 to 15 year life span as cells from the endothelium are lost during the graft process and do not get replaced so gradually get less as time goes on which can result in a regraft.


The aim of this procedure as with any other surgical technique used to manage keratoconus is to proved a corneal surface that enables vision to be corrected easier with glasses or contact lenses.


Complications
Infection
Migration
Perforation; anterior/exterior (the incision are ruptures)
Under or over correction
Poor centration
Wound desicance
Epithelial down growth
Crystalline deposits


Conclusions
Intrasomal implants (Intacs) are a new treatment for selected patients. Initial data suggests sight is improved however there is no long term data available yet.

This procedure is available on the NHS in the hospitals that do perform this operation, however there is a wait. This is because funding has to be applied for so that the operation can be paid for out of the hospitals allocated budget. All surgeons need to be certified as being competent to perform this operation.

Regards

Gareth Beynon
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Re: Intacs

Postby linda36 » Fri Oct 05, 2007 1:15 pm

THANK YOU FOR THE INFO ON INTACS. SIX WEEKS AGO MY ELEVEN YEAR OLD SON WAS TOLD HE HAD KERATOCONUS. AT THE MOMENT IT IS JUST IN ONE EYE BUT I HAVE BEEN TOLD IT COULD DEVELOP IN THE OTHER EYE. I HAVE BEEN TOLD HE HAS TO HAVE INTACS. HAVE YOU HEARD OF A CHILD HAVING INTACS
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Re: Intacs

Postby GarethB » Fri Oct 05, 2007 7:40 pm

Never heard of a child having intacs, but the fact is they can be removed if necessary.

Many can go the rest of their lives successfully with just contact lenses.

I do know many surgeons do not like to even contemplate grafts on a youngster until they have stopped growing.

A final thing to remember is that KC can stabalise in some people, mine has been stable for over three years.
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Re: Intacs

Postby Karl R » Sat Oct 06, 2007 5:52 am

Hi Linda and welcome

I've not heard of any surgeon who will do INTACS on a patient under the age of 18, the primary reason being that the teen years is when KC develops at it's fastest rate and it is difficult to tell what severity of KC a patient will eventually have at this age. The curve of the rate of development of KC is exponential to age, i.e the older you are the slower it is to develop.
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Re: Intacs

Postby linda36 » Sat Oct 06, 2007 9:02 am

Thank you for the info. I am so pleased to find that there is other people out there that i can ask questions that i seem to forget when faced with the consultant. I am told we have chosen a fantastic hospital. My son is coping very well considering his vision is only very slight in one eye [about six inches] I hope that the KC doesnt develop in the other eye, if it does as quickly as it has in the other we have to consider a graft, the consultant being very reluctant considering his age.This is a whole new world for my husband and I and we have hope for the future. Thanks again :)
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Re: Intacs

Postby Tom » Sun Aug 31, 2008 1:30 pm

Hi, you say Intacs are available on the NHS. At which hospitals do they perform the op? I'm guessing not many.....

Thanks

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Re: Intacs

Postby rosemary johnson » Sun Aug 31, 2008 11:03 pm

Hi, and sorry to hear about the shock news you and your son have just had.
I do hope your hospital are not trying to talk of surgical options before exploring the various possibilities of contact lenses.
Even after a graft, chances are he'd have to be wearing contact lenses - the grafts make it easier to correct the vision, and don't necessarily give godd unaided vision.
Keep us posted with how you get on. And please don't be afraid of writing down your questions and turning up with a notebook.
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Re: Intacs

Postby Andrew MacLean » Mon Sep 01, 2008 10:21 am

Tom

INTACS has been approved by NICE as a standard treatment to be available all over England (their remit does not run to other parts of the UK). If you know of a hospital in England that is denying patients access to this treatment, then you ought to ask them 'why?'

Andrew
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Re: Intacs

Postby Lizb » Fri Sep 05, 2008 12:12 pm

Andrew MacLean wrote:Tom

INTACS has been approved by NICE as a standard treatment to be available all over England (their remit does not run to other parts of the UK). If you know of a hospital in England that is denying patients access to this treatment, then you ought to ask them 'why?'

Andrew


When was it approved on the NHS across England? I went to one of the Manchester hospitals earlier this year (May/June) and was told that if i wanted it done i would have to pay privately, the only hospital that did intacs on the NHS was one down south somewhere.
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Re: Intacs

Postby linda36 » Wed Sep 10, 2008 9:09 pm

Hello

Just to verify, on our first consultation in August 2007 we discussed all options for the treatment of keratoconus. The first option for my son was the trial of contact lens which unfortunately has been a very slow process considering his age and the severity of his right eye. The second option was intacs which we were told was still very new but available if the other eye starts to develop keratoconus. The third option was a graft. His left eye then was very good.

Unfortunately I am now told that he has bilateral keratoconus however only very slight in his "good eye". It is a great worry for me as I am told the younger you get it the faster it develops. Unfortunately no one can tell how fast it will develop or if it will.

As you will agree all we can do is hope and accept advice from anywhere.

Kind regards

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