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Combined femtosecond laser-assisted intracorneal ring segment implantation and corneal collagen cross-linking for correction of keratoconus

Authors Ibrahim O, Elmassry A, Said A, Abdalla M, EL HENNAWI H, Osman I

Received 25 September 2015

Accepted for publication 18 December 2015

Published 22 March 2016 Volume 2016:10 Pages 521—526


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Osama Ibrahim,1 Ahmed Elmassry,1 Amr Said,1,2 Moones Abdalla,2 Hazem El Hennawi,1 Ihab Osman1

1Department of Ophthalmology, Alexandria University, Alexandria, Egypt; 2Roayah Vision Correction Center, Alexandria, Egypt

Purpose: To assess the safety, predictability, and effectiveness of Keraring intrastromal corneal ring segments (ICRS) insertion assisted by femtosecond laser and corneal collagen cross-linking (CXL) for keratoconus correction.
Patients and methods: In this prospective, noncomparative, and interventional case series, 160 eyes of 100 adult keratoconus patients with poor best-corrected visual acuity (BCVA) (less than 0.7) and intolerance to contact lens wear were included. Patients underwent femtosecond laser-assisted placement of ICRS and CXL. All patients were examined for a complete ophthalmological test: uncorrected visual acuity (UCVA), BCVA, spherical equivalent, keratometry (K1-flat and K2-steep), pachymetry, and Scheimpflug imaging with the Pentacam at 1 week and at 1, 3, and 6 months postoperatively.
Results: At 6 months, a significant difference was observed (P<0.001) in mean UCVA and BCVA from 0.92±0.677 and 0.42±0.600 logMAR preoperatively to 0.20±0.568 and 0.119±0.619 logMAR, respectively. Mean spherical equivalent refractions were significantly lower (P<0.001) at 6 months. Mean keratometry (K) also significantly reduced (P<0.001) from 50.93±5.53 D (K1-flat) and 55.37±5.76 D (K2-steep) to 47.32±4.61 and 51.08±5.38 D, respectively. In terms of pachymetry, no significant difference was observed preoperatively versus postoperatively (P=1.000).
Conclusion: Keraring ICRS insertion assisted by femtosecond laser and corneal CXL provided significant improvement in visual acuity, spherical equivalent, and keratometry, which suggests that it may be effective, safe, and predictable for keratoconus correction.

Keywords: keratometry, pachymetry, keratectesia, Pentacam, irregular astigmatism

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