Intacs with or without same-clay corneal collagen cross-linking to treat corneal ectasia

Objective: To compare combined intrastromal corneal ring segment implantation with same-day ultraviolet-A/riboflavin corneal collagen cross-linking (ICRS-CXL) versus ICRS implantation alone in patients with corneal ectasia. Design: Retrospective comparative study. Participants: Sixty-six eyes from 54 patients with corneal ectasia were included in the study. The groups were composed of 32 eyes from 27 patients and 34 eyes from 27 patients for the ICRS-CXL and ICRS groups, respectively. Methods: We reviewed the charts of all patients who underwent these procedures from November 2008 to February 2011 for preoperative and for up to 1 year postoperative uncorrected (UDVA) and best corrected distance visual acuity (BDVA), refraction, topographical analysis (mean and steepest keratometry [K]), as well as root mean-square (RMS) of higher-order aberrations (HOAs). Results: Overall, a significant improvement was seen in both groups for UDVA, BDVA, sphere, cylinder, mean refractive spherical equivalent (MRS E), mean and steepest K, coma, spherical and total HOA at 12 months. Trefoil did not improve, and higher-order astigmatism worsened in the ICRS group (p = 0.0466). There was no statistically significant difference between the 2 groups for visual acuity, sphere, cylinder, coma, trefoil, and spherical HOA. Outcomes were significantly more improved in the ICRS group for MRSE (p = 0.0082), mean K (p = 0.0021), steepest K (p = 0.0152), and total HOAs (p = 0.0208). No complications were observed. Conclusions: ICRS-CXL and ICRS alone were both safe and effective in treating corneal ectasia. The ICRS alone group demonstrated better outcomes of MRSE, mean and steepest K, as well as total HOA.