Visual rehabilitation in low-moderate keratoconus:intracorneal ring segment implantation followed by same-day topography-guided photorefractive keratectomy and collagen cross linking
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(1.Department of Ophthalmology, Faculty of Medicine, Cukurova University, Saricam, Adana 01380, Turkey;2.Ermenek State Hospital, Ermenek, Konya 70200, Turkey;3.Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Altindag, Ankara 01100, Turkey)

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Conflicts of Interest: Zeraid FM, None; Jawkhab AA, None; Al-Tuwairqi WS, None; Osuagwu UL, None.
ACKNOWLEDGEMENTS: The authors extend their appreciation to the Research Centre, College of Applied Medical Sciences and the Deanship of Scientific Research at King Saud University for funding this research.

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    Abstract:

    AIM:To present the results of same-day topography-guided photorefractive keratectomy (TG-PRK) and corneal collagen crosslinking (CXL) after previous intrastromal corneal ring segment (ISCR) implantation for keratoconus.METHODS:An experimental clinical study on twenty-one eyes of 19 patients aged 27.1±6.6y (range 19-43y), with low to moderate keratoconus who were selected to undergo customized TG-PRK immediately followed by same-day CXL, 9mo after ISCR implantation in a university ophthalmology clinic. Refraction, uncorrected distance visual acuities (UDVA) and corrected distance visual acuities (CDVA), keratometry (K) values, central corneal thickness (CCT) and coma were assessed 3mo after TG-PRK and CXL.RESULTS:After TG-PRK/CXL:the mean UDVA (logMAR) improved significantly from 0.66±0.41 to 0.20±0.25 (P<0.05); Kflat value decreased from:48.44±3.66 D to 43.71±1.95 D; Ksteep value decreased from 45.61±2.40 D to 41.56±2.05 D; Kaverage also decreased from 47.00±2.66 D to 42.42±2.07 D (P<0.05 for all). The mean sphere and cylinder decreased significantly post-surgery from, -3.10±2.99 D to -0.11±0.93 D and from -3.68±1.53 to -1.11±0.75 D respectively, while the CDVA, CCT and coma showed no significant changes. Compared to post-ISCR, significant reductions (P<0.05 or all) in all K values, sphere and cylinder were observed after TG-PRK/CXL.CONCLUSION:Same-day combined topography-guided PRK and corneal crosslinking following placement of ISCR is a safe and potentially effective option in treating low-moderate keratoconus. It significantly improves all visual acuity, reduced keratometry, sphere and astigmatism, but causes no change in central corneal thickness and coma.

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Ferial M. Zeraid, Asma A Jawkhab, Waleed S Al-Tuwairqi, et al. Visual rehabilitation in low-moderate keratoconus:intracorneal ring segment implantation followed by same-day topography-guided photorefractive keratectomy and collagen cross linking. Int J Ophthalmol, 2014,7(5):800-806

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Publication History
  • Received:November 18,2013
  • Revised:December 31,2013
  • Adopted:December 31,2013
  • Online: October 20,2014
  • Published: