Corneal Collagen Cross-Linking Before Ferrara Intrastromal Corneal Ring Implantation for the Treatment of Progressive Keratoconus

Abstract

FR implantation after CXL is a safe and efficacious treatment option for managing selected patients with progressive keratoconus. Good results in terms of visual acuity, postoperative residual refractive error, and keratometry values were obtained. Longer follow-up would be valuable to confirm the stability of these results.

Corneal collagen cross-linking in keratoconus – long-term prospective study

“…He had grater reduction in cylinder and keratometry than ICR alone, which testifies the effect of cross-linking. The study of Henriquez et al [17], who used cross-linking before ICR, had better results than our study. It demonstrates the additional effect of ICR, as following: UCVA preoperatively was 1.11 logMAR, after CXL 0.75 logMAR P = 0.03, and 0.23 logMAR after 6 months after ICR implantation P < 0.001; BCVA at 1 year was 0.05; spherical equivalent had a P value < 0.001; keratometric values at 6 months after ICR implantation were statistically decreased P = 0.01.…”

Cross-Linking and Intracorneal Ring Segments—Review of the Literature

“…[24][25][26][27][28][29][30][31][32] In a retrospective nonrandomized comparative case series by Chan and Sharma, 25 12 eyes (9 patients) underwent inferior-segment Intacs placement without CXL and 13 eyes (12 patients) underwent inferior-segment Intacs placement followed by CXL with UV light and riboflavin. Previous studies reported that combining these two complementary interventions has been shown to be safe and effective.…”

“…Various sequences of treatments have been described: performing CXL before ICRS implantation, 27,30,31 after, 24,[27][28][29]33,37 or on the same day 25,26,37 with controversial results. It is still unclear whether the cornea first needs to be reshaped by the ICRS before it is stabilized by CXL, whereas CXL before ICRS placement may stiffen the cornea and prevent the ICRS from causing significant corneal flattening.…”

“…It is still unclear whether the cornea first needs to be reshaped by the ICRS before it is stabilized by CXL, whereas CXL before ICRS placement may stiffen the cornea and prevent the ICRS from causing significant corneal flattening. Henriquez et al, 30 in their small prospective case series of 9 eyes with progressive keratoconus and a preoperative cylinder value equal to or greater than 5 D, showed that CXL followed by ICRS (Ferrara rings) 6 months later led to statistically significant improvements in the UCVA, reduction in mean spherical equivalent, and reduction in mean maximum and minimum keratometry values 6 months after ICRS placement. The mean UDVA and CDVA improved in both groups; overall, there was more improvement in CDVA, SE, and mean K in group 2 than in group 1.…”

Outcome of Keratoconus Management: Review of the Past 20 Years' Contemporary Treatment Modalities

“…There are many combination procedures such as CXL and ICRS implantation [107][108][109][110] and CXL and PRK [111][112][113][114][115] reported in the literature. The purpose of these combined procedures is to augment the effect of the individual procedure in KC.…”