gms | German Medical Science

Corneal Inlays are an exciting new modality for the correction of Presbyopia. There are 3 major types in various stages of development: pinhole, non-refracting and refracting. In general, they have achieved a satisfaction rate of at least 90%.

Many challenges that must be overcome: biocompatibility, permeability to essential nutrients which dictates the optimum depth of placement in the cornea, method (flap or pocket?), effect of pupil size.

Patient selection is critical. The ocular surface must be perfect. Visual side effects are common: patients must be highly motivated and understand that their recovery might take several weeks to months. Avoid the picky low myope!

Intra-operative considerations: same day surgery (pocket at 250 mu, flap at 100 mu, inlay, excimer). Need a coaxial light to center on the1^st Purkinje reflex. Surgical technique is key. Too much manipulation or stretching results in prolonged visual recovery.

Post-operative considerations: Mid-point refraction, management of dry eye, length of topical steroid treatment required (with ancillary risk of ocular hypertension). It is not yet clear how the different inlays affect the measurement of intra-ocular pressure.

27 patients were implanted with the Acufocus Kamra inlay. 13 were immediately happy, 11 were happy after a delay of up to several months (3 inflammation with hyperopic shift requiring steroids, 4 lasik to adjust refraction, 4 prolonged symptoms of glare-ghosting), and 3 required explantation because of inflammation and hyperopic shift not responsive to steroids. Also, some patients developed a ‘Red Ring’ on topography.

The presenter will report his personal experience with his Kamra inlay implanted by Dr. Minoru Tomita in June 2012: the best decision of my life! In conclusion, corneal inlays for presbyopia are here to stay. Just like the development of IOLs, there will certainly be progressive improvements in this technology and they will become part of the main stream of refractive surgery.