TOTAL KERATOCONUS SOLUTION 2013Keraring Global User Meeting

Challenging Cases With Keraring SI-6

Nicolas Cesário PereiraHospital Oftalmológico de Sorocaba

Banco de Olhos de Sorocaba

nicolascepe@gmail.com

Diferences KeraringSI-5 and SI-6

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)

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

Keraring SI-6

Surgical Technique

� Manual: Use 6mm marquers and tunelizers

� Femtosecond laser: Channel diameter 5,8 and 7,0

Case 1Keratoconus with low corrected VA and CL intolerant OS

VA n/c OS CF 2mOS -5,75 -0,50 150 20/60-2

SI6 150/300

SI6 90/250

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

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

Case 2:

Plan: Explant segments OD e reprogram implant after 3 months

Case 2:

PO

VA n/c 20/30Rx +0,50 -1,00 a 90 20/20p Implant SI-6 150/250

SI6 - 150/250

SKF, 41y

LASIK 9y

Low corrected VA OU

CL intolerant OU

Case 3

VA OD n/c 20/600,00 -3,50 a 110 20/30p

SI6 - 150/200

POVA n/c 20/20

0,00 - 1,00 10 20/15p

VA OS n/c 20/160-0,50 -5,50 110 20/40p

SI6 - 150/250

POVA n/c 20/15plano 20/15

SI6 - 150/250

AOC, 82y

Low VA AO 5y

No other comorbity

Case 4

SI6 - 150/250

Case 4

OSOD

Periferic Marginal Degeneration (Senile)Cataract +/IV

SI6 - 150/250

Case 4 ODVA OD n/c 20/200

+4,75 -3,25 a 70 20/40p

SI6 - 150/250

Case 4 OSVA n/c 20/400+6.25 -8.00 a 95 20/120

SI6 90/200

SI6 150/250

SI6 - 150/250

Case 4 OSVA n/c 20/40+2.50 -0.50 a 95 20/30

SI6 - 150/250

Cataract surgery 3 months later

VA n/c OD 20/40 OS 20/25

OD +0.50 -2.50 a 70 20/20pOS +0.75 -0.75 a 95 20/20

Case 4

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

Thank You!

nicolascepe@gmail.com