Intracorneal ring segment implantation is an effective procedure for visual and refractive improvement in keratoconic eyes. The addition of TE-CXL to the procedure compensates for residual superficial irregularities, disrupts the progression of the disease, and provides greater improvements in spherical values. The process is simply a deep stretch with superficial lamellar stiffness.

Purpose The aim of this study was to analyze the effectiveness, predictability, and aberrometric changes of implanted intracorneal ring segments (ICRSs) with sequential cross-linking (CXL) in keratoconus patients during a 24-month follow-up period. Patients and methods This is a prospective cohort study that was carried out on 21 eyes of 17 keratoconus patients. ICRS were implanted in these eyes during the period from 2013 to 2017. Mechanical dissection of the lamellar pockets was the technique used. This was followed by CXL 6 weeks later. Patients were followed up to assess refraction, topography, and aberrometry at 6, 12, and 24 months postoperatively. Aberrometry used coefficient settings in the NIDEK OPD-Scan for more sensitivity. The main outcome measures included uncorrected visual acuity, best-corrected visual acuity, refraction, keratometric values, total root mean square at the 3 mm zone, coma order (7), coma order (8), and trefoil order (6) of high-order aberrations. Results There was a statistically significant improvement in uncorrected visual acuity and best-corrected visual acuity, with a significant reduction in the refractive error and the mean keratometry values (P<0.001). In addition, there was a statistically significant improvement in total root mean square, 6-Trefoil, 7-Coma, and 8-Coma coefficients (P<0.001) only at the sixth postoperative month. Coma 7 progressively improved till 24 months. The mean keratometry values showed a small, insignificant regression at the 12-month follow-up, but stabilized at the 24th month postoperatively. Conclusions ICRS, followed by CXL was an effective method for improving and stabilizing visual, keratometric, and aberrometric values in keratoconus.