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Sequential ICRS implantation and corneal transepithelial CXL in keratoconus

Poster Details

First Author: A.Saif USA

Co Author(s):    M. Ahmed   H. el Saftawy   M. Saif              

Abstract Details


To assess the safety and efficacy of sequential transepithelial corneal collagen cross linking (CXL), after surgical implantation of Kera intracorneal ring segments (ICRS) in keratoconus eyes.


Multicentre study, Research Institute Of Ophthalmology , Beni Suef university and Memorial Institute Of Ophthalmology, Cairo Egypt.


This retrospective comparative study included 40 consequitive eyes of 29 patient with progressive, mild to moderate Keratoconus that were randomly divided into two groups. Group 1 included 20 eyes that underwent kerarings (Mediphacos Inc., Belo Horizonte, Brazil) implantation, and group 2 included 20 eyes that underwent kerarings insertion followed by transepithelial CXL one month later. In both groups channel creation was performed manually.


There was statistically significant improvement in both groups, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), with significant reduction in refractive error and keratometric values (p<0.05). There was no statistically significant difference between both groups regarding changes in UDVA, CDVA and refractive error (p>0.05). However, group 2 revealed more statistically significant reduction in spherical refraction after 3m and highly significant improvement after 6m.


ICRS implantation is an effective procedure for visual and refractive improvement in keratoconic eyes. However, the addition of TE- CXL to the procedure compensates for residual superficial irregularities , disrupts the progression of the disease and provides greater improvements in spherical values . The process is simply a deep stretch with a superficial lamellar stiffness .

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