Comparative Results in a Combined Procedure of Intrastromal Corneal Rings Implantation and Cross-linking in Patients with Keratoconus: A Retrospective Study

Abstract

IntroductionCorneal thinning disorders caused by keratoconus often lead to protrusion, irregular astigmatism, and even perforation. Keratoconus, like other corneal ectasia, does not have a known cause. Severe cases of keratoconus may require correction or restoration of tectonic integrity of the cornea by surgical means. Intracorneal ring segments are a new modality in the treatment of corneal ectactic disorders. A new technique of stopping the evolution of keratoconus and strengthening the cornea is combining techniques of intrastromal corneal ring implantation and corneal collagen cross-linking. The objective of the study is to compare the effectiveness of combined procedures: intrastromal corneal ring implantation followed by cross-linking, with cross-linking followed by intrastromal corneal ring implantation.MethodsThe study comprised two groups of patients with different evolutionary stages of keratoconus, which met the eligibility criteria for intrastromal corneal ring segment implantation and corneal collagen cross-linking. Group 1 included patients (41 eyes) who underwent intrastromal corneal ring implantation followed by cross-linking and group 2 (30 eyes) included patients who underwent cross-linking first followed by intrastromal corneal ring implantation.ResultsA decrease in Km values of about 1.5 D and refraction was observed in group 1, compared to a decrease in Km values of about 1 D and refraction in group 2. Recovery of visual acuity was higher in group 1 than group 2.ConclusionsThe sequence of intrastromal corneal ring implantation followed by cross-linking proved to be more effective in reducing Km values, spherical equivalent and cylinder compared with cross-linking followed by intrastromal corneal ring implantation.

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“…The preoperative diagnostic of keratoconus even in a suspect stage is very important in obtaining the expected visual results. 15,16 The inflammatory cytokines in the lacrimal tear in patients with keratoconus may alter the postoperative outcomes. 17 A special attention must be given to patients with dry eye disease or meibomian gland dysfunction who can be very unsatisfied after the surgery due to subjective symptoms, regardless of multifocal IOL implantation.…”

A Combined Procedure of Intrastromal Corneal Rings Explantation and Penetrating Keratoplasty in a Patient With Keratoconus: A Case Report

“…Apart from rigid contact lenses, frequently used para-surgical techniques include intrastromal corneal ring segments (ICRS) implantation and corneal collagen cross-linking (CXL) ( 5 ).…”

“…Alternatively, CXL should be performed after ICRS implantation and only after careful follow-up. In case of disease progression, it may be advisable to skip CXL in favor of PKP or DALK ( 5 ). In pediatric age, ICRS are contraindicated, mainly because of easy ring extrusion and important risk of perforation related to growth and development of the eyeball.…”

Modern methods of surgical treatment of keratectasias

“…Активная работа ведется в направлении разработки комбинированных вмешательств -КРК + ICRS. C. Nicula и соавторы пришли к выводу, что комбинация методов имеет синергетический эффект [24].…”