Refractive Surgery Complex Case Management

Brian S. Boxer Wachler, MD The significant findings are lamellar channel deposits and superior neovascularization. The former are benign; they do not affect corneal health but can cause cosmetic concerns. Lamellar channel deposits can sometimes cause glare if the ring segment is located close to the pupil or if the pupil is large. These deposits are more likely to occur in wide versus narrow channels. In the figure, the ring segment is located quite temporally in the periphery, so it is unlikely to be causing glare, which makes the device’s removal medically unnecessary. If the patient is concerned about cosmesis, however, the segment could be explanted, and some (but probably not all) of the deposits will resorb over time. The neovascularization appears to be superficial rather than in the channel itself. The absence of stromal opacification in the region of the nasal segment supports this impression. Assuming that the vessels are indeed superficial, I would recommend observation. If they are in the channel, however, then I would consider explanting the nasal Intacs segment. If the patient wears soft contact lenses, she should use a design with a high oxygen content to avoid oxygen stress that could promote the further growth of blood deposits and neovascularization after implantation of intrastromal Corneal rings