Intrastromal keratoplasy with segment implantation in combination with corneal collagen cross-linking

• Main Authors: Z.I. Moroz, S.B. Izmaylova, S.L. Legkikh, D.E. Merzlov
• Format: Article
• Language: Russian
• Published: Publishing house "Ophthalmology" 2013-03-01
• Series: Офтальмохирургия
• Subjects: cross-linking; keratoconus; progressive keratoconus; intrastromal keratoplasty
• Online Access: http://www.eyepress.ru/article.aspx?12782
• ISSN: 0235-4160; 0235-4160

ABSTRACT Purpose. To evaluate the efficacy of intrastromal keratoplasy with intra-corneal ring segment (ICRS) implantation in combination with corneal collagen cross-linking in the treatment of early and advanced keratoconus. Material and methods. In the study 183 eyes with keratoconus were included: 87 eyes (47.5%) with the stage II and 96 eyes (32.5%) with stage III. The ICRS were implanted as a first step of treatment in 98 cases (53.5%), cross-linking was performed 3 months later. In 85 cases (46.4%) the CXL was performed as a first step followed by the ICRS implantation after 3 months. Results. Patients were examined 3, 6, 24 months after surgery. Best functional results were obtained after the ICRS implantation: UCVA and BCVA increased by 3-5 lines, mean keratometry readings decreased by 3.5-4D, the average spherical equivalent decreased by 3.2-2.75D, astigmatism decreased by 2.6-3.9D. After the subsequent CXL procedure, there was a slight improvement of the obtained results. The results obtained in the groups І and II differed insignificantly and were almost identical. At 24 months after surgery some deterioration of functional results was detected in 23.1-26.7% of cases. In the rest of the cases, the obtained effect remained stable. Conclusions. 1. Intra-corneal ring segments implantation and cross-linking are aimed to halt a keratoconus progression and have been successfully used to treat the disease of initial and far-advanced stages. 2. The combination of both methods gives better functional results regardless of which method is performed as a first step. 3. The choice of method to be performed as a first step of treatment depends on the central pachymetry and corneal thickness in a 5-7mm zone of ectasia. 4. Interval between the first and the second step of treatment has to be 3 months or more.