Keratoconus is a very frustrating diagnosis. Many patients report that their glasses no longer provide clear vision and that contact lenses which once worked well for them become more and more uncomfortable over time. As a result they tend to look into advanced treatment options beyond what is typically presented for keratoconus. One such option is INTACS which we use to improve the shape of the cornea and in turn improve visual quality without the removal of corneal tissue.
At ASG Eye Hospital we see many patients that ask if INTACS can do away with the need for a corneal transplant or if it can return vision to normal. The answer is that it depends on the stage of keratoconus, the thickness of the cornea and the health of the eye in general. Learning how INTACS works is key to an informed decision making process for your vision care.
Understanding Keratoconus and Why It Affects Vision
Keratoconus is a progressive eye disease that sees the cornea slowly become thinner and develop a cone-like shape. As the cornea is the element which focuses light on the retina any change in its shape brings about blurred vision, ghost images, glare, halos, and also a great deal of difficulty in daily activities. In the early stages glasses may give good vision.
As the disease progresses many patients are put into rigid contact lenses. But when contact lenses are no longer tolerated by the patient or they no longer provide sufficient correction then advanced eye treatments like INTACS surgery may be a solution.
What Is INTACS Surgery?
INTACS surgery procedure is a type of corneal surgery which is very minimal in nature. In this procedure we put in very small plastic ring segments into the cornea. These rings help to flatten out and regularize the corneal surface which in turn improves how light enters the eye. Also unlike laser based vision correction methods which remove corneal tissue, INTACS does not remove any tissue. What it does is that it changes the biomechanical structure of the cornea to reshape it.
This feature of INTACS surgery makes it very useful for certain patients of keratoconus who are having issues with their vision but are not at a stage which requires a corneal transplant. Also from a research point of view it has been proven that intracorneal ring segments like INTACS surgery do improve the corneal shape and visual results in the right set of keratoconus patients.
How INTACS for Keratoconus Works
When it comes to INTACS surgery for keratoconus what we must understand is that the cure is not the goal. What we see with INTACS surgery is an improvement in corneal symmetry and a reduction in irregular astigmatism. The implanted segments produce a flatter central cornea. From this many patients see an improvement in visual quality and in their tolerance to wear glasses or contacts. In some cases INTACS surgery is used in conjunction with corneal collagen cross-linking to improve both visual rehabilitation and long-term corneal stability.
How INTACS Changes the Cornea
| Before INTACS Surgery | After INTACS Surgery |
| Irregular corneal shape | More regular corneal contour |
| Distorted vision | Improved visual quality |
| Significant irregular astigmatism | Reduced irregular astigmatism |
| Poor contact lens tolerance | Better lens tolerance in many patients |
| Higher risk of progressing to transplant | Potential delay or avoidance of transplant in selected cases |
Who Is a Candidate for INTACS Surgery?
Not all keratoconus patients are good candidates for INTACS surgery. We have in depth evaluation by a cornea specialist before any treatment is decided upon.
In many cases which do benefit from INTACS surgery we see mild to moderate keratoconus, adequate corneal thickness and difficulty getting good vision out of glasses or contact lenses. A cornea specialist will look at the topography of the cornea, thickness of the tissue, and the health of the eye before putting forward the idea of INTACS surgery.
Also, those with very advanced corneal scarring or very thin corneas may do better with different approaches to treating their keratoconus.
The INTACS Surgery Procedure
One of the reasons that many patients choose to have INTACS surgery is that it is a short and very minor procedure.
Beforehand local anesthetics in the form of drops are used to numb the eye. Then a femtosecond laser or a special surgical tool is used to make channels in the cornea. The INTACS surgery segments are put in these channels and placed to achieve the which is required for the patient’s corneal issue.
Also most INTACS surgeries are done in the range of 20 to 30 minutes. Patients go home the same day and also are able to get back to most of their normal activities right away.
INTACS Surgery Timeline
| Stage | What Happens |
| Pre-operative evaluation | Corneal mapping and eligibility assessment |
| Day of surgery | Ring segments implanted into cornea |
| First week | Mild discomfort and visual fluctuations |
| First month | Vision gradually stabilizes |
| 3–6 months | Maximum visual improvement often achieved |
| Long-term follow-up | Monitoring by a cornea specialist |
Benefits of INTACS for Keratoconus
The main benefit of INTACS surgery in keratoconus is that they improve visual quality at the same time as they preserve corneal tissue. Many patients which we report to have had INTACS surgery note a reduction in visual distortion and an improvement in functional vision.
Also a benefit of INTACS surgery is that the procedure is reversible. Should the issue prove to be temporary the ring segments may be removed or adjusted. This feature which we find to be very attractive makes INTACS surgery an excellent choice for selected patients that are looking for options before going into corneal transplantation.
Also reported in the clinical studies which we looked at was that the intracorneal ring segments improve visual acuity, reduced corneal steepening, and decreased irregular astigmatism in many keratoconus patients.
Risks and Limitations of INTACS Surgery
Although in general INTACS surgery is very safe, no surgery is fully without its risks.
Some patients have experienced glare, halos, problems with night vision, infection, inflammation, segment movement or under correction.
Also in a few cases it may become a case that the segments be removed. Also important is to know that INTACS doesn’t put a stop to keratoconus progression on its own. For those with progressive disease other treatments for keratoconus may still be put forth.
Recovery After INTACS Surgery
Recovery from INTACS surgery is for the most part very easy. We see that most patients have mild issues like discomfort, watering eyes, light sensitivity and fluctuating vision in the first few days.
Vision usually begins to improve within the first few weeks but full stabilization may take up to several months. While a patient is in the recovery stage it is important they follow the medication regiments exactly as instructed and keep to all of the follow up visits with your cornea specialist.
The success of INTACS surgery is a result of the procedure which is performed and also of the postoperative care which is given and the regular monitoring that follows.
Can INTACS Surgery Replace a Corneal Transplant?
A frequent patient inquiry is if INTACS surgery is a cure for corneal transplantation. For many patients INTACS surgery does improve vision greatly and delays the performance of more in depth procedures. But we do see that in cases of severe keratoconus, extensive corneal scarring, or late stage disease that some may still require a transplant even after INTACS surgery. We use INTACS surgery in the management of keratoconus to improve the corneal shape which in turn we hope will restore functional vision and at the same time reduce the patient’s dependence on more radical interventions.
INTACS Surgery at ASG Eye Hospital
At ASG Eye Hospital it is our practice to put all patients that are interested in INTACS surgery through a thorough evaluation by a skilled cornea specialist. We use detailed corneal imaging to determine which patients will do best with INTACS surgery for keratoconus and which may do better with other eye treatments. We take a very individualized approach as each patient’s case is unique in terms of corneal shape, disease progression and visual requirements.
Key Takeaway
INTACS surgery procedure is a good choice for certain keratoconus patients that are seeing their vision degenerate and are intolerant to contact lenses. What the INTACS surgery do is they reshape the cornea which in turn improves vision quality, reduces irregular astigmatism and also may put off the need for corneal transplant. It is very important that you have a full evaluation by a qualified cornea specialist before you decide on INTACS surgery.
Frequently Asked Questions
1. What is INTACS surgery?
INTACS surgery is a low invasive surgery that involves the implantation of small corneal ring segments into the cornea which in turn improves its shape and visual performance in patients with keratoconus.
2. How effective is INTACS for keratoconus?
For keratoconus INTACS surgery does improve corneal symmetry, reduce irregular astigmatism, and also improves visual quality in those patients that are appropriate for the treatment.
3. Is INTACS surgery painful?
Most patients report only minor discomfort during the INTACS surgery procedure which is managed with the use of anesthetic eye drops. Mild irritation is a possibility during the recovery period.
4. Can INTACS for keratoconus stop disease progression?
No. What INTACS surgery for keratoconus does is to improve corneal shape and vision. For treatment of keratoconus which also includes slowing progression of the disease you may need to also do cross linking.
5. How long does recovery take after INTACS surgery?
Most patients get back to normal activity in a few days but full visual stabilization from the surgery may take a few months.
6. Can INTACS surgery be removed?
Yes. A benefit of INTACS is that the segments which are put in can be removed or adjusted should that be required.
