Efficacy of Intrastromal Corneal Ring Segments Combined With Flash Collagen Cross-Linking in Keratoconus.

PURPOSE To evaluate outcomes, efficacy, and safety of intrastromal corneal ring segment implantation for treatment of keratoconus combined with collagen cross-linking (CXL) with 1-year follow-up. METHODS One hundred nineteen eyes of 82 patients with keratoconus (37 females) underwent femtosecond (Intralase FS; Abbott Medical Optics, Inc) laser-assisted intrastromal corneal ring segment implantation (INTRASEG; Gamma Vision) with flash CXL (18 mW/cm for 5 minutes). The outcome measures were uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), subjective refractive error, keratometry values, and corneal thickness. RESULTS Mean age of patients at implantation was 31 years (range 12-63, SD 9.5). According to the Amsler-Krumeich scale of keratoconus severity, 62 eyes were type 1 (52%), 43 eyes, type 2 (36%), and 14 eyes, type 3 (11.8%). Statistically significant improvement of UDVA/CDVA and reduction in the mean cylinder and mean keratometry at 1 year were observed. Mean UDVA (logMAR) was 1.11 ± 0.61 (SD) preoperatively and 0.54 ± 0.58 (SD) postoperatively (P < 0.001). Mean CDVA was 0.52 ± 0.18 (SD) preoperatively and was 0.14 ± 0.17 (P < 0.0001) postoperatively. Preoperative Kmax was 48.75 diopters (D) (range 41.0-55.0 D), and postoperative Kmax was 46.18 D (P < 0.0006); preoperative Kmin was 44.69 D (SD) 3.59 and postoperative Kmin was 43.00 D (SD) 2.53. The mean cylinder was -5.19 D preoperatively (range -0.80 to -8.80 D) and -2.6 D (range -1.00 to -7.25) postoperatively. Mean corneal pachymetry was 486.6 μm (range 391-591). No intraoperative complications occurred. No patient lost any lines of UDVA or CDVA. CONCLUSIONS Implantation of the INTRASEG with the Intralase combined with flash CXL was apparently safe and effective in treatment of keratoconus. The variety of options in thickness and arc length of the segments enables more precise correction of keratoconus and refractive errors.

[1]  J. Alió,et al.  Intrastromal Corneal Ring Segments: How Successful is the Surgical Treatment of Keratoconus? , 2014, Middle East African journal of ophthalmology.

[2]  P. Vinciguerra,et al.  Two-year corneal cross-linking results in patients younger than 18 years with documented progressive keratoconus. , 2012, American journal of ophthalmology.

[3]  Y. Mandel,et al.  Clinical and Corneal Biomechanical Changes After Collagen Cross-Linking With Riboflavin and UV Irradiation in Patients With Progressive Keratoconus: Results After 2 Years of Follow-up , 2012, Cornea.

[4]  David Touboul,et al.  Corneal collagen crosslinking in progressive keratoconus: Multicenter results from the French National Reference Center for Keratoconus , 2011, Journal of cataract and refractive surgery.

[5]  M. Mannis,et al.  Riboflavin/Ultraviolet A Corneal Collagen Cross-linking for the Treatment of Keratoconus: Visual Outcomes and Scheimpflug Analysis , 2011, Cornea.

[6]  I. Bahar,et al.  Intrastromal corneal ring segment SK implantation for moderate to severe keratoconus , 2010, Journal of cataract and refractive surgery.

[7]  J. Alió,et al.  Refractive and aberrometric outcomes of intracorneal ring segments for keratoconus: mechanical versus femtosecond-assisted procedures. , 2009, Ophthalmology.

[8]  R. Shetty,et al.  Intacs in Advanced Keratoconus , 2008, Cornea.

[9]  A. Ertan,et al.  Intacs implantation using a femtosecond laser for management of keratoconus: Comparison of 306 cases in different stages , 2008, Journal of cataract and refractive surgery.

[10]  Eberhard Spoerl,et al.  Collagen crosslinking with riboflavin and ultraviolet‐A light in keratoconus: Long‐term results , 2008, Journal of cataract and refractive surgery.

[11]  M. Jankov,et al.  One-year results of intrastromal corneal ring segment implantation (KeraRing) using femtosecond laser in patients with keratoconus. , 2008, American journal of ophthalmology.

[12]  C. Rapuano.  Intrastromal Corneal Ring Segment Implantation by Femtosecond Laser for Keratoconus Correction , 2008 .

[13]  Hassan Hashemi,et al.  Intracorneal ring segment implantation for the management of keratoconus: Safety and efficacy , 2007, Journal of cataract and refractive surgery.

[14]  J. Alió,et al.  Intrastromal corneal ring segment implantation by femtosecond laser for keratoconus correction. , 2007, Ophthalmology.

[15]  Nikolaos S. Tsiklis,et al.  Long-term follow-up of Intacs in keratoconus. , 2007, American journal of ophthalmology.

[16]  Jorge L. Alió,et al.  Intracorneal ring segments for keratoconus correction: Long‐term follow‐up , 2006, Journal of cataract and refractive surgery.

[17]  H. Kamel,et al.  Cost-Effectiveness of Smoking Cessation Interventions in Patients With Ischemic Stroke and Transient Ischemic Attack , 2023, Stroke.

[18]  J. Stevens,et al.  Surgical treatment of keratoconus at the turn of the 20th century. , 2001, Journal of refractive surgery.

[19]  N. Maeda,et al.  Changes in anterior and posterior corneal curvatures in keratoconus. , 2000, Ophthalmology.

[20]  Y. Rabinowitz,et al.  Interobserver and intraobserver reliability of a classification scheme for corneal topographic patterns , 1998, The British journal of ophthalmology.

[21]  J. Krumeich,et al.  Live‐epikeratophakia for keratoconus , 1998, Journal of cataract and refractive surgery.

[22]  P. Asbell,et al.  The intrastromal corneal ring segments. Phase II results for the correction of myopia. , 1997, Ophthalmology.

[23]  J. Jiménez,et al.  Keratoconus: age of onset and natural history. , 1997, Optometry and vision science : official publication of the American Academy of Optometry.