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High astigmatism post DALK, simultaneous treatment with combined ICRs and cross-linking

Poster Details

First Author: J.Grandin ARGENTINA

Co Author(s):    C. Gordillo   A. Lotfi                 

Abstract Details


To evaluate the efficacy and safety of the combined intracorneal ring segment implantation (ICR) Intraseg assisted with femtosecond laser for tunnel creation in association with simultaneous Flash Cross Linking in peripherial cornea for the reduction of high astigmatism in patients who have previously undergone a deep anterior lamellar keratoplasty (DALK) and have high astigmatism and topographic instability.


All surgeries were performed at Cornea Department Zaldivar Institute- Mendoza, Argentina.


This retrospective observational study included patients with previou keratoconus that underwant DALK and after 1 year or more of surgery had a high residual astigmatism and corneal instability. 32 patients were implanted with ICRs assited with femtosecond laser (IntraLase), in the same procedure collagen flash cross-linking was performed including the receptor corneal ring area. Complete ophthalmologic examinations, uncorrected visual acuity (UCVA), best corrected visual acuity (CDVA), keratometric values (Orbscan Corneal Topographer, Bausch & Lomb) and corneal thickness were performed Data were measured preoperatively, and at 1, 6, 12 and 24 months after the surgery.


Thirty-two eyes from 32 patients (42.75 �Â�± 15.49 years) were analyzed, the mean time between corneal graft surgery and ICR implantation was 34 months. Mean UCVA (logMAR) changed from 1.15 �Â�± 0.47 preoperatively to 0.19 �Â�± 0.14 postoperative (p <0.001), and CDVA from 0.35 �Â�± 0.19 to 1.2 �Â�± 2.64 ( P <0.0001). The values of Kmax decreased from 51.14 D preoperatively to 47.30 D (p <0.0003) postoperatively, mean cylinder decreased from -7, 10 (range -3.50 to -10) to -4.2 (range -1 to -7). There were no intra or post-operative complications.


The combined technique ICRs and simultaneous Cross linking is a promising option for the management of elevated astigmatism in patients who have previously undergone DALK, presenting surface regularization and stability in final refraction, avoiding keratometric changes due to a progression of peripheral keratoconus.

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