Purpose
To evaluate the efficacy of single or paired intrastromal corneal ring segments (ICRS) combined with ultraviolet-A and riboflavin collagen crosslinking (CXL) in patients with keratoconus.
Setting
Cornea Unit, Toronto Western Hospital, Toronto, Ontario, Canada.
Design
Retrospective comparative case series.
Methods
Consecutive patients with keratoconus had femtosecond laser–assisted ICRS implantation combined with same-day CXL between 2008 and 2011. The main outcome measures included improvement in visual acuity, subjective refractive error, keratometry values, and total higher-order aberration (HOA).
Results
Eighty-five eyes of 74 patients with keratoconus (paired ICRS: 47 eyes of 40 patients; single ICRS: 38 eyes of 34 patients) were included in the study. The uncorrected distance visual acuity was significantly improved after single ICRS (3.4 lines; P=.04) and paired ICRS (2.7 lines; P=.01) implantation combined with CXL, while corrected distance visual acuity (CDVA) remained stable. The single and paired ICRS groups had a significant reduction in mean cylinder at 1 year (single ICRS: −3.84 diopters [D] ± 1.72 [SD] versus −2.19 ± 1.54 D, P=.02; paired ICRS: −3.91 ± 1.45 D versus −2.96 ± 1.92 D) (P=.02). There was no significant difference in total HOAs. Single ICRS implantation and paired ICRS implantation with CXL were equivalent in all refractive parameters. No patient lost lines of CDVA.
Conclusion
As determined by corneal topography, implantation of single or paired ICRS combined with same-day CXL was safe and effective in patients with keratoconus.
Financial Disclosure
No author has a financial or proprietary interest in any material or method mentioned.
