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Intracorneal ring segment (ICRS) implantation and corneal collagen cross-linking (CXL) using intracorneal riboflavin injection into corneal ring tunnel

Poster Details

First Author: M.Tomita JAPAN

Co Author(s):                        

Abstract Details


To evaluate one year postoperative visual and refractive outcomes after femtosecond laser assisted intra corneal ring segment (ICRS) implantation followed by corneal collagen cross-linking (CXL) using intra-corneal riboflavin injection into corneal ring tunnel.


Tomita Minoru Eye Clinic, Tokyo, Japan


This retrospective study included 188 eyes of 132 patients with keratoconus or post-LASIK ectasia. All eyes underwent the OCT guided LDV Z8 femtosecond laser assisted Keraring implantation. ICRS implantation was followed by a new method of CXL involving no need of epithelium removal (Riboflavin 0.25% was injected into the tunnel; after waiting for 5 minutes, the tunnel was washed with BSS and then UVA exposure of 18mW for 5 minutes was applied). At 1, 3, 6 and 12 months postoperatively, the parameters evaluated were visual acuity, refraction and keratometry.


Improvements in refractive, keratometric and visual acuity parameters were observed from preoperative to all postoperative follow-up time points with best outcomes at 6 and 12 months postoperatively. At the last follow-up visit at 12 months, K mean was 47.73±5.19D (versus 50.5±6.47D preoperatively), and astigmatism was -3.24±2.10 D (versus -4.86 ±4.64D preoperatively). Preoperative versus 12 months postoperative MRSE were -8.20±6.19D and -6.22±5.10D respectively. UDVA (logMAR) and CDVA (logMAR) improved from preoperative levels of 1.14±0.46 and 0.23±0.30 to respectively 0.74±0.45 and 0.16±0.25 postoperatively.


The OCT guided femtosecond laser assisted Intra-corneal ring implantation followed by corneal CXL (involving riboflavin injection into the corneal tunnels) is effective and safe treatment for keratoconus or post LASIK ectasia. The procedure resulted in significant improvement in visual acuity, refractive, and keratometry parameters. CXL method utilized does not involve removal of epithelium; thus, providing the benefits such as quick recovery and less pain. Additionally, there is no need to apply soft contact lens (as in standard CXL) which is occasionally associated with the risk of infection.

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