TREATMENT TACTICS AND OUTCOMES OF COMPLICATIONS IN IMPLANTATION OF CORNEAL SEGMENTS FOR KERATECTASIA OF VARIOUS GENESIS

Purpose. To evaluate the nature and frequency of intraand postoperative complications in intracorneal ring segments (ICRS) implantation for keratectasia of various etiology and to develop methods for their prevention and treatment.Material and methods. The investigation enrolled 189 patients (274 eyes) with keratoconus of the stage II (142 eyes) and stage III (102 eyes), PMD (12 eyes) and secondary keratectasia after laser refractive surgery (18 eyes). In 113 cases the surgery was performed with classical manual technique, in 161 cases we used an improved technique with vacuum fixation of the eyeball.Results. There were revealed 16 cases of complications (5.8%) including: 4 intra-operative corneal micro-perforations, 1 excessively deep segment implantation (directly at the Descemet’s membrane); in postoperative period – 2 cases of adenoviral keratitis (14 and 19 days post-op.) and 9 segment extrusions (3-8 months post-op.). In one case of too deep implantation the DALK was performed, in cases of microperforations we implanted the segment through the incision located in the meridian opposite to perforation. In 2 keratitis cases the ICRS were removed and the pharmacological therapy was performed. Segments were again implanted 6 months later. In case of extrusions, the ICRS were removed and re-implanted 3 to 6 months later. The refractive outcomes in patients having complications were comparable with the control group.Conclusion. The moderate number of complications (5.8%), the majority of which were stopped due to subsequent conservative and/or surgical interventions, testifies to a relative safety of intrastromal keratoplasty. Vacuum fixation of the eyeball secures a lesser complication rate (1/4 from initial). In consequence the possibility of secondary ICRS implantation was proved that provides high refractive results.