CXL and intracorneal ring segment combo provides good long-term results

ICR implanted using femtosecond laser and crosslinking in keratoconus patients 

is a safe and effective procedure with long-term stability and has a good 

impact on corneal biomechanics, Moones Abdalla MD, Roaya Vision Centre 

Alexandria, Egypt, told the 18th ESCRS Winter Meeting in Ljubljana, Slovenia. 

Dr Abdalla presented findings from a prospective noncomparative case series 

of 682 eyes of 433 keratoconus patients who underwent the crosslinking 

intracorneal ring segment procedure at yesterday’s free paper session on Special 

Cases.

In all cases, Dr Abdalla and his associates created the tunnels and incision for 

the ring segments with VisuMax femtosecond laser (Carl Zeiss Meditec) and 

performed five minutes epi-off crosslinking. The implants included INTACS and 

Ferrara ring segments. They were placed at a 75 per cent and 80 per cent depth 

based on OCT measurements leaving a stromal bed of at least 100 microns. 

At one year’s follow-up mean decimal UCVA had improved from 0.2 

preoperatively to 0.67 and mean spherical equivalent improved from -7.93 D 

preoperatively to -3.61 D. Furthermore, mean keratometry improved from 54.2 

D preoperatively to 44.2 D, remaining stable throughout follow-up. In addition, 

mean corneal hysteresis and mean corneal resistance factor, as measured by the 

ORA (Reichert) changed by 16.7 per cent and 21.7 per cent, respectively.

Complications included an incomplete tunnel in one eye and a perforation in one 

eye.

“Our results show that combined collagen crosslinking and intracorneal ring 

segment implantation increase corneal strength and enhance visual acuity and 

quality,” Dr Abdalla concluded.