Intracorneal Ring Segments Implantation Followed by Same-day Topography-guided PRK and Corneal Collagen CXL in Low to Moderate Keratoconus

PURPOSE: To evaluate the safety and efficacy of intrastromal corneal ring segments (ICRS) implantation followed by same-day topography-guided photorefractive keratectomy (PRK) and ultraviolet-A/riboflavin collagen cross-linking (CXL) in patients with low to moderate keratoconus. METHODS: Patients with low to moderate keratoconus and contact lens intolerance were included in the study. All patients first underwent femtosecond laser-enabled placement of ICRS (Keraring, Mediphacos) (first step). Same-day topography-guided PRK and CXL (second step) were subsequently performed in all patients after the refraction was stable (average 6 months [range: 3 to 11 months]). RESULTS: Thirteen eyes from 13 patients were included in the study. Based on values before the first step and 6 months after the second step, significant improvements were noted in uncorrected distance visual acuity (0.7 +/- 0.32 logMAR vs 0.08 +/- 0.08 logMAR), corrected distance visual acuity (CDVA) (0.16 +/- 0.19 logMAR vs 0.02 +/- 0.04 logMAR), sphere (-3.65 +/- 3.08 diopters [D] vs 0.06 +/- 1.6 D), astigmatism (-3.31 +/- 1.5 D vs -0.98 +/- 0.75 D), average K (47.28 +/- 1.99 D vs 41.42 +/- 3.22 D), and coma (2.36 +/- 1.23 mu m vs 1.47 +/- 0.68 mu m) (P<.05). Approximately 63% of eyes gained >= 2 lines of CDVA, whereas no change in CDVA was reported in similar to 27% of eyes. No eyes lost lines of CDVA. CONCLUSIONS: The combination of ICRS implantation followed by sequential same-day topography-guided PRK/CXL may be a reasonable option for improving visual acuity in patients with low to moderate keratoconus. [J Refract Surg. 2013;29(1):59-63.] doi:10.3928/1081597X-20121228-04