Pediatric Keratoconus: Five-Year Follow-Up Of Standalone Intrastromal Corneal Ring Segment Implantation
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR388 | Type: Free paper | DOI: 10.82333/w987-vc72
Authors: Dr Vera Sá Araújo* 1 , Dr Francisca Maia 1 , Dr Rui Silva 1 , Dr Christophe Pinto 1 , Dr José Carlos Mendes 1 , Dr Nuno Franqueira 1 , A/Prof. Tiago Monteiro 2
1Ophthalmology,Unidade Local de Saúde de Braga,Braga,Portugal, 2Ophthalmology,Unidade Local de Saúde de São João,Porto,Portugal
Purpose
To evaluate the long-term safety and efficacy of standalone ICRS implantation in pediatric keratoconus over a 5-year period.
Setting
ULS de Braga, Braga, Portugal
Methods
A longitudinal study was conducted including pediatric patients (≤18 years) with keratoconus who underwent manual implantation of Ferrara-type ICRS at a tertiary referral center. Eyes with previous ocular surgery or ocular/systemic diseases affecting the cornea were excluded. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, keratometry, corneal topography, and coma-like aberrations were assessed preoperatively and at 6 months, 12 months, and 5 years postoperatively. Statistical analysis included paired t-tests and repeated-measures ANOVA, with p < 0.05 considered significant.
Results
Forty-five eyes of 32 patients (mean age 15.4±1.96 years) underwent successful ICRS implantation without complications.At 6 months, UDVA improved from 0.88±0.38 to 0.52±0.32 logMAR (p<0.01), and eyes with CDVA ≤0.1 logMAR increased from 8.9% to 40%. Significant refractive and tomographic improvements were also observed, including reductions in spherical equivalent, cylinder, keratometry values and coma-like aberrations (p<0.001). Efficacy and safety indices were 1.18 and 2.13. Visual and refractive outcomes remained stable at 12 and 60 months (p >0.05). Although increases in maximum keratometry >1.5 D occurred in eight eyes and in topographic cylinder >1.5 D in three eyes, only four eyes lost two or more lines of CDVA.
Conclusions
ICRS provides significant and sustained improvements in visual acuity, refractive error, and corneal topography in pediatric keratoconus, in line with previously published studies reporting visual improvement and corneal flattening. These visual and refractive gains were largely maintained at the 5-year follow-up, with only minimal progression observed in a minority of cases. Overall, the findings support ICRS as a safe and effective treatment option in pediatric keratoconus, while emphasizing the need for long-term monitoring and further research to clarify the role of adjunctive corneal cross-linking, particularly in high-risk subgroups.