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An evaluation of sequential intrastromal corneal ring segment insertion and accelerated collagen corneal cross-linking with pulsed light

Poster Details

First Author: M.Schneiders UNITED ARAB EMIRATES

Co Author(s):    A. Barsam              

Abstract Details


Intrastromal corneal ring segments (ICRS) have been shown to flatten the central cornea and improve refractive outcomes in keratoconus. Collagen corneal crosslinking (CXL) with riboflavin and ultraviolet-A light has complemented ICRS by also arresting the progression of corneal ectasias. Traditionally CXL is applied using the Dresden protocol. Pulsed and accelerated CXL enhances the traditional approach by reducing the treatment time, while maintaining safety and efficacy. The purpose of this study is to evaluate the sequential use of ICRS followed by pulsed and accelerated CXL.


Department of Ophthalmology, Luton and Dunstable University Hospital NHS Foundation Trust, Luton and Dunstable University Hospital, Bedford, England, United Kingdom


Retrospective consecutive clinical evaluation of six (n=6) patients with progressive severe keratoconus, treated with sequential ICRS and CXL procedures. All patients initially underwent treatment with KeraRing (Mediphacos) ICRS. At three months post-IRCS, pulsed and accelerated CXL was performed. A riboflavin soak was applied over an induction period of 10 minutes, followed by UV-A administration at 30mW/cm2, pulsed (1 second on, 1 second off) over 8 minutes with an intended energy dose of 7.2J/cm2. Clinical evaluation and Scheimpflug analysis (Oculus Pentacam®) were performed prior to surgery and at 2, 4, and 6 months post-operatively. The outcomes included best corrected (BCVA) distance visual acuities, maximum keratometry (KMax) and astigmatism.


All patients underwent sequential ICRS and CXL with a mean patient age of 23.4. A minimum of a six month follow-up period, post CXL, was obtained in all cases. No complications occurred. There was no evidence of topographical progression in keratoconus with mean pre-operative KMax of 60.4 (+/-SD 5.8). This value reduced to 56.49D, at two months post ICRS, and then 54.45D (+/-SD 6.29) at 6 months following CXL. Visually, BCVA improved from logmar 0.54 (+/- 0.14) to 0.32 (+/-0.17) at 6 months post CXL.


Our results show that ICRS can be safely and effectively integrated with pulsed and accelerated collagen corneal crosslinking. This sequential technique combines and enhances the improved visual outcomes and corneal topography of ICRS with the ability of pulsed and accelerated CXL to stabilise progressive keratoconus. FINANCIAL INTEREST: NONE

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