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Refractive and Topographic Results of Transepithelial Cross-Linking Treatment in Eyes With Intacs

Ertan, Aylin MD; Karacal, Hümeyra MD; Kamburoğlu, Günhal MD

doi: 10.1097/ICO.0b013e318191b83d
Clinical Science

Purpose: To evaluate the efficacy of transepithelial cross-linking (CXL) in keratoconic eyes after Intacs implantation.

Patients and Methods: Twenty-five eyes of 17 patients with bilateral keratoconus underwent Intacs implantation with subsequent cross-linking (CXL) treatment. Inclusion criteria were absence of corneal scarring, contact lens intolerance, corneal thickness higher than 400 μm, and endothelial cell density more than 3000 per square millimeter. Preoperative and 3-month-postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refractions, and mean and steepest keratometric (K) values were reviewed retrospectively. The results in Intacs group were compared with those obtained after CXL/Intacs.

Results: There were 10 males and 5 females; mean age was 25.14 ± 7.11 (range 16-39) years old. Mean time between implantation of Intacs and CXL was 3.98 months. CXL after Intacs resulted in an additional improvement in UCVA, BCVA, sphere, cylinder, and keratometry. Intacs resulted in an improvement of 1.9 Snellen lines (P < 0.05) of UCVA and 1.7 Snellen lines (P < 0.05) of BCVA. CXL performed after Intacs treatment yielded an additional 1.2 Snellen lines (P < 0.05) of UCVA and 0.36 Snellen lines (P < 0.05) of BCVA. The decrease in spherical, cylindrical, mean K, and steepest K values was 2.08 diopters (D) (P < 0.05), 0.47 D (P > 0.05), 2.22 D (P < 0.05), and 1.27 D (P < 0.05), respectively, after Intacs treatment with an additional 0.5 D (P < 0.05), 0.15 D (P > 0.05), 0.35 D (P > 0.05), and 0.76 D (P < 0.05) of improvement gained after CXL in each respective parameter.

Conclusions: Intacs implantation with transepithelial CXL is effective in eyes with keratoconus. Collagen cross-linking has an additive effect on Intacs implantation in these eyes and may be considered as an enhancement/stabilizing procedure.

From the *Department of Cataract and Refractive Surgery, Kudret Eye Hospital, Ankara, Turkey; and †Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO.

Received for publication November 18, 2007; revision received October 6, 2008; accepted October 15, 2008.

Authors have no financial interest.

Reprints: Aylin Ertan, MD, Department of Cataract and Refractive Surgey, Kudret Eye Hospital, Kennedy Caddesi No. 71, Kavaklidere, Ankara, Turkey 06660 (e-mail:

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