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Intracorneal ring segments in keratoconus and subsequent surgical procedures: a retrospective study

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Session Details

Session Title: Cornea Surgical II

Session Date/Time: Tuesday 16/09/2014 | 08:00-10:30

Paper Time: 09:39

Venue: Boulevard B

First Author: : A.Vicente PORTUGAL

Co Author(s): :    L. Vieira   R. Anjos   N. Alves   V. Maduro   J. Feijão   P. Candelária

Abstract Details


The authors present an analysis of subsequent surgical procedures performed and outcomes in patients with keratoconus following intracorneal ring segment insertion.


Department of Ophthalmology - Centro Hospitalar Lisboa Central - Lisbon, Portugal


A retrospective study of 422 eyes (326 patients) with keratoconus submitted by the same surgical team to intracorneal ring segment insertion between 2006 and 2013. Demographic data, surgical indications, type of procedure, visual outcome, refractive outcome and complications were studied. A comparison between the eyes that required a second surgical procedure and the others was performed. The safety and efficacy of the procedures was also studied.


4,2% (n=15) of the eyes were submitted to a subsequent surgical procedure after intracorneal ring segment insertion. The second surgical procedure was performed in average 20,1 months after the first. Indications for surgery included keratoconus progression (40%; n=6), cataract (33,3%, n=5), ring segment migration (20%; n=3) and extrusion (6,7%; n=1). Cataract surgery was performed in 33,3% (n=5) of the reoperated eyes, implantation of new intracorneal ring segments in 26,7% (n=4), deep anterior lamellar keratoplasty in 13,3% (n=2), penetrating keratoplasty in 13,3% (n=2) and cross-linking in 13,3% (n=2). There were no postoperative complications. A significant improvement in corrected distance visual acuity and manifest refraction was obtained (p<0,05).


Only a small percentage of the patients submitted to intracorneal ring segments insertion had to be reoperated. Furthermore, only 66,6% of the subsequent procedures were related to keratoconus and a good outcome was achieved. The low rate of re-intervention suggests that the progression of keratoconus submitted to ring segment implantation may not be clinically significant. Our study suggests that ICRS implantation has revolutionized the keratoconus standard of treatment, leaving more aggressive procedures to the severe and refractive spectrum of the disease.

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