One-Year Results of Intrastromal Corneal Ring Segment Implantation (KeraRing) using Femtosecond Laser in Patients with Keratoconus

Outcome Analysis of Intracorneal Ring Segments for the Treatment of Keratoconus Based on Visual, Refractive, and Aberrometric Impairment

“…[19][20][21] Most of the published studies analyzing the effectiveness of ICRS implantation for the treatment of keratoconus agree that there is a significant flattening of the central cornea after the procedure. [4][5][6][7][8][22][23][24][25] Our results confirm that finding, as we found a statistically significant reduction in the keratometry readings in all grades of keratoconus. We observed that the largest reduction in mean keratometry was found in those cases with the most severe disease.…”

“…There are several publications in the literature showing that ICRS implantation in keratoconus eyes results in an improvement of the CDVA. 4,5,8,11,[20][21][22][23][24]29 However, in the present study, patients with the milder form of the disease (patients classified as grade I) showed a statistically significant decrease in the CDVA. This might be related to the fact that in those investigations, the analysis of the outcomes regarding CDVA was performed evaluating all the population under study as a whole, without considering the degree of visual impairment.…”

“…1 A variety of options have been described for the management of this pathologic condition, such as rigid gas-permeable contact lenses, 2 corneal collagen cross-linking, 3 intracorneal ring segment implantation, [4][5][6][7][8][9][10][11] or keratoplasty. 12 In a number of studies intracorneal ring segments (ICRS) have been demonstrated to be effective in improving visual acuity and reducing the refractive error and the mean keratometry in selected cases of keratoconic eyes.…”

“…[4][5][6][7][8][9][10][11] Such a positive therapeutic effect is considered to be based on the induction of a remodeling of the corneal anterior and posterior surface's topography, which improves the optical quality of the cornea and reduces the optical aberrations, with consequent improvement in best-corrected visual acuity. [4][5][6][7][8][9][10][11] Although in the healthy cornea, the sectorial arcuate addition to the corneal local volume caused by these implants at the corneal midperiphery induces a flattening of the central cornea in an arc-shortening effect, with the consequence of a decrease in myopic spherical equivalent attributable to the overall reduction in the optical power of the cornea, 13 such corneal modeling effect may be different in structurally abnormal corneas such as in keratoconus. 14 Even though the effectiveness of ICRS in the correction of keratoconus has been the subject of a number of studies and investigations, most reported evidence is based on the study of limited case series and may reflect only the experience of 1 surgeon or a limited and specific study group.…”

“…Most of the studies that have evaluated the impact of ICRS in the management of keratoconus patients reported a significant improvement in the UDVA. [4][5][6]8,10,21,[25][26][27] In addition, studies that have analyzed the clinical outcomes according to the severity of the disease also reported a significant improvement in patients who suffered from a severe form of keratoconus. 5,21,27 By analyzing the results according to the degree of visual limitation, we found that more than 65% of our patients gain at least 1 line of UDVA after the primary implantation of the ICRS.…”