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A comparative clinical trial on intra corneal ring segments (ICRS) with and without sequential cross-linking in moderate keratoconus: a better together concept

Poster Details

First Author: L.Daniel Ponniah INDIA

Co Author(s):    M. Ali   M. Ramesh                 

Abstract Details


To compare the long term efficacy of addition of sequential cross-linking procedure to implantation of Intra Corneal Ring Segments in dampening progression of ectasias in corneas with moderate keratoconus


A Prospective non-randomized comparative clinical trial at the Department of Cornea at a tertiary eye hospital in South India


Eyes with moderate keratoconus, corneal thickness greater than 400 microns, and endothelial cell density more than 2000 were grouped as follows. Group 1 eyes underwent Femto assisted ICRS with collagen cross-linking (3MW/cm2 with UVA for 30 minutes) on the same day. Group 2 eyes underwent ICRS alone. Preoperative and 18 months postoperative vision in Log MAR, corneal astigmatism, maximum and mean keratometry values in Diaptors, thinnest Pachymetry in microns were analyzed for statistical significance in both groups, in addition to estimation of depth demarcation line (DL) at 1 month in Group 1.


13 in Group1 and 19 in Group2 enrolled. UCVA, BCVA improved by 3 and 2 Snellen's lines respectively in both groups. Astigmatism reduced by 6.03 ±1.44D in Group1 and 5.69±1.94D in Group2. Corneas flattened in both groups (K max reduced by 3.75D and 2.99 D, K mean reduced by4.22 D and 2.01D in Groups 1 and 2 respectively). Pachymetry was maintained in Group1 whereas significantly reduced by 24 microns (p=0.007) in Group2. DL in Group1 was 214.34±24.81 suggesting CXL efficacy. In group2 one subject had stromal melt and extrusion of the ring (5.26%). One had progressive keratoconus underwent DALK


Intracorneal ring segments are an effective tool to reverse irregular astigmatism due to keratoconus. Collagen cross-linking is a useful tool in preventing progression of keratoconus, with probable additional benefit to prevent keratolysis predisposing device extrusion and migration. The combined procedure of CXL with Intracorneal rings is found to be effective than ICRS alone in moderate Keratoconus and act as a proof of ‘Better together’ concept

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