Intrastromal Corneal Ring Segments Implantation And Corneal Cross-Linking For Keratoconus In Children With Vernal Keratoconjunctivitis - Three-Year Results

Purpose: To assess the 3-year safety and efficacy of femtosecond laser-assisted intrastromal corneal ring segments' (ICRS) implantation followed or accompanied by transepithelial accelerated corneal collagen cross-linking (TE-ACXL) as a treatment of keratoconus in children with vernal keratoconjunctivitis (VKC). Patients and methods: Fifty two eyes of 28 children with keratoconus and vernal VKC were included in this study. Cases were divided into 2 groups; the first group had been treated with femtosecond laser-assisted ICRS (Keraring) implantation accompanied or followed by TE-ACXL, while the second group had been treated by TE-ACXL only and all cases completed a follow-up period of 3 years. Results: In group 1: the mean uncorrected (UCVA) and best-corrected (BCVA) visual acuity, spherical equivalent, K-max and Q-value improved markedly from 0.97 +/- 0.19, 0.67 +/- 0.18, -8.75 +/- 4.55, 60.41 +/- 4.98, and -1.18 +/- 0.54 preoperatively to 0.61 +/- 0.27, 0.39 +/- 0.21, -3.25 +/- 3.56, 55.22 +/- 5.72, and -0.44 +/- 0.68 postoperatively respectively. While in group 2: the preoperative mean UCVA, BCVA, spherical equivalent, K-max and Q-values were 0.68 +/- 0.28, 0.38 +/- 0.24, -2.84 +/- 2.59, 50.29 +/- 4.04, and-0.58 +/- 0.23 respectively while their corresponding postoperative values were 0.58 +/- 0.34, 0.19 +/- 0.17, -2.35 +/- 2.07, 49.58 +/- 3.26, and -0.57 +/- 0.25. Only one case in group 1 required repeat cross-linking. Conclusion: Although the long-term safety and efficacy of femtosecond laser-assisted ICRS implantation accompanied or followed by TE-ACXL in children with keratoconus and VKC is high, some cases still may need repeat cross-linking.