Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus

PURPOSE: To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients. DESIGN: Retrospective interventional case series. METHODS: This retrospective study included pediatric patients (aged <= 14 years) with keratoconus and poor corrected distance visual acuity (CDVA) that underwent ICRS implantation and cross-linking (CXL). ICRS were inserted under topical anesthesia after creating a corneal tunnel with a femtosecond laser. Cross-linking was performed 1 month subsequently. Records were reviewed and data collected preoperatively and at 6 months, 1 year, 2 years, and 4 years postoperatively. RESULTS: Twelve patients (17 eyes; 10 male, 2 female) aged 9-14 years (mean age 12.3 years) received ICRS implantation followed by CXL. Follow-up times ranged from 6 months to 4 years after surgery. At the 6-month follow-up all eyes were evaluated; at the 1-year, 2-year, and 4-year follow-up 11, 10, and 7 eyes were evaluated, respectively. At the 6-month follow-up, mean CDVA in comparison to preoperative levels improved significantly (P = .001) from 0.30 0.19 logMAR to 0.12 0.1 logMAR; mean uncorrected distance visual acuity (UDVA) also improved significantly from 0.90 0.50 logMAR to 0.43 0.31 logMAR. A significant decrease in both keratometry readings and spherical equivalent (from -4.0 to -1.56 diopters) was also noted after ICRS insertion. At the 1-year, 2-year, and 4-year follow-up refractive values remained relatively stable in comparison to the 6-month follow-up, except for a minor but significant improvement in cylinder and, at 4 years, in UDVA. All patients tolerated the surgery well and no intraoperative or postoperative complications were reported, except for 1 ring segment that had to be removed after 2 years owing to vascularization and corneal thinning. CONCLUSION: ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA. (C) 2017 Elsevier Inc. All rights reserved.