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Evaluation of the effect of the intrastromal corneal ring implantation and corneal cross-linking as methods of stabilization of corneas in patients with higher grades of keratoconus

Poster Details

First Author: K.Buusova Smeckova CZECH REPUBLIC

Co Author(s):    J. Madunicky   J. Pasta   K. Sicova   I. Nemcova   K. Hladikova  

Abstract Details


The aim is to evaluate stabilization effect of CXL and intra-stromal corneal ring implantation in patients keratoconus grade 2,5 and higher. Follow up is 2 years.


Eye department of the First Faculty of Medicine and Central Military Hospital in Prague, Czech Republic


Retrospective study of two groups of patients with keratoconus grade 2,5 to 3,5. First group (40 members) was treated with trans-epithelial corneal cross-linking (dosage and time according to Dresden Protocol), second group (78 members) was treated by keraring/s implantation followed in 2 months by trans-epithelial CXL (dosage and time according to Dresden Protocol). Tunnel for kerarings was created by a femtosecond laser iFS 150. Study was focused on signs of progression. Maximal keratometry, pachymetry and grade of keratoconus were measured prior surgery and 2 years after. Keratometry was evaluated as a change in value and a percentage of patients worsen/unchanged/improved. All standard examinations were performed and any unusually findings have been reported.


None of the patients required keratoplasty. Grade of keratoconus changed from 3,08 to 2,6 in ring group. CXL only group showed slight worsening (3 to 3,06). Maximal keratometry improved by 2,49 [-10,0 ; +3,1] in ring group and decreased by 1,13 [/11,2 ; 5,2] in 2 years after the surgery. Keraring was much more successful from the perspective of % of patients with reduced maximal keratometry (78% vs. 16% with CXL only). Analogically 51% of patients in CXL only group showed increase in maximal keratometry opposite to only 11% in keraring+CXL group, which showed also a 0,2 increase on UCVA.


Patients with advanced stages of keratoconus gained profit from both methods of treatment. To a certain extent, both methods have a potential to slow down progression and therefore postpone the need for keratoplasty. When both approaches are compared, combination of both keraring implantation and CXL seems to be more effective from the perspective of maximal keratometry change, pachymetry reduction and lines gained after the procedure. Based on our experience, patients are advised to treat their eyes with the combination of both methods and CXL as a single therapy is devoted to patients with keraring contraindications (severe atopia, etc.) or financial limitations. FINANCIAL DISCLOSURE?: No

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