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

Abstract

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.

One-Year Clinical Outcomes of a Two-Step Surgical Management for Keratoconus—Topography-Guided Photorefractive Keratectomy/Cross-Linking After Intrastromal Corneal Ring Implantation

“…The Ocular Wavefront Analyser and the Corneal Wavefront Analyser are reliable and have been recommended for use in refractive surgery, even though the Hartmann-Shack device was favored. 28 Although studies [12][13][14][15][16][18][19][20][21]23,34,35 have shown similar significant improvements in most of the tested visual functions, they have been conducted on a different population sample and/or have not agreed on all findings, partly because of the variation in the surgical protocol, and data collection/analysis method or follow-up duration. Additionally, many of these studies have been performed on a few eyes 15,16,20,21,23 and have used a format which is different from that recommended 25,26 in presenting their graphic data, thus making it difficult to directly compare results between studies.…”

“…7,9 However, a combination of various techniques such as conductive keratoplasty, 10 photorefractive keratectomy (PRK), [11][12][13][14] intrastromal corneal ring (ISCR) implantation plus PRK, 15,16 non-topography-guided PRK after ISCR implantation, 17 and simultaneous wavefront-guided PRK 18 with CXL maximizes the results by providing an overall additive effect on visual acuity, keratometry, and stability of the condition. 11,15,16,[19][20][21][22][23] Same-day simultaneous topography-guided PRK and CXL was shown to be superior to sequential CXL with later PRK in the visual rehabilitation of progressing keratoconus. 24 Despite the reported safety and improvements in visual functions associated with a same-day combined surgical approach, few studies have followed up the patients beyond 6 months postoperatively and the procedure is uncommon among practitioners in the Middle East despite the increasing number of keratoconus referrals.…”

“…5 This study aims to evaluate the efficacy of ISCR implantation followed no less than 6 months later by same-day topography-guided photorefractive keratectomy (TG-PRK) combined with CXL for visual rehabilitation in patients with keratoconus (two-step procedure). To enable the comparison of the outcomes of this study with those of other studies, to enhance easy recognition, and to allow the reader to quickly find some basic information, 10,12,[20][21][22][23] the results were reported using the standards outlined for reporting outcomes of refractive surgery but often ignored by researchers. 25,26 …”

Keratoconus: How Best to Treat it?

“…15 Mahipal Sachdev: We have been performing ICRS for more than 5 years now and results in most patients are good. There is signifi cant improvement in UCVA and BCVA in about 70% patients which is maintained long term ( Figure 1).…”

“…The results in my hands have been favourable, with stable topography 1 year post treatment and signifi cant improvement of biomechanics. 14,15 Charu Khurana: How oft en do you perform Intra-corneal ring segments (ICRS) for keratoconus patients? Sudhank Bharti: ICRS can provide an improvement in visual acuity because they improve the central corneal curvature.…”