Riboflavin injection into the corneal channel for combined collagen crosslinking and intrastromal corneal ring segment implantation

PURPOSE: To evaluate the effectiveness of intracorneal riboflavin injection for combined collagen crosslinking (CXL) and intrastromal corneal ring segment (ICRS) implantation. SETTING: Kudret Eye Hospital, Ankara, Turkey. DESIGN: Noncomparative case series. METHODS: Keratoconic eyes had combined ICRS (Intacs) implantation and transepithelial CXL with 20% alcohol application and riboflavin injection into the corneal channel. Outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, sphere, cylinder, and keratotomy (K) readings. RESULTS: The study enrolled 131 eyes (105 patients) with a mean follow-up of 7.07 months +/- 4.66 (SD). The mean improvement was 0.26 +/- 0.16 logMAR in UDVA and 0.24 +/- 0.16 logMAR in CDVA (both P<.05). The mean manifest spherical refraction decreased from -3.87 +/- 4.55 diopters (D) to -1.25 +/- 2.31 D, the mean manifest cylinder improved from -3.89 +/- 1.97 D to -2.27 +/- 2.18 D, and the mean K reading improved from 50.50 +/- 5.26 D to 46.03 +/- 4.51 D (all P<.05). There were no intraoperative or postoperative complications. CONCLUSIONS: Combined ICRS and CXL treatment with intracorneal riboflavin injection was effective in keratoconic eyes. Intracorneal riboflavin injection into the tunnel was safe and may provide more penetration without epithelial removal.