Combined Excimer Laser Surgery and High-Energy Accelerated Crosslinking After Intracorneal Ring Implantation for Keratoconus Treatment
Narrative Responses:
Purpose
To determine the safety and efficacy of simultaneous laser-assisted sub-epithelial keratectomy (LASEK) and accelerated corneal Crosslinking after intracorneal ring segment (ICRS) implantation in patients with early keratoconus.
Methods
We included patients with early keratoconus who received an ICRS(Keraring, Mediphacos) at least 1 year before enrolment. LASEK was performed with the Amaris 750S (Schwind)using customized profiles, optical zones between 6 to 6.5 mm, and ablations between 13 to 74 µm. Next, eyes were soaked with riboflavin for 60 seconds and irradiated for 75 seconds at 30 mW/cm2with the KXL System for accelerated crosslinking (Avedro).Follow-up was performed at 3 months and included the following measurements: UCVA, BCVA, refraction, keratometry (K), placido topography (KeratronScout, Optikon), and Scheimpflug imaging (Sirius, CSO Inc. and Pentacam, Oculus).
Results
This study included 6 eyes (5 patients, 4 male) of mean age 34 ± 10 years (range 27-47 years). Thirty-three percent of patients had stage 1 keratoconus whereas 66% had stage 2 keratoconus. There was a significant improvement in mean UCVA (0.78 vs 0.31; p<0.001), BCVA (0.84 vs 0.75; p=0.02), sphere (0.54 vs -0.46 D; p=0.05), cylinder (-0.46 vs -1.92 D; p=0.001), and K average (42.03 vs 43.08 D; p=0.02) at the 3-month follow-up as compared to pre-operatively. Although Kmax improved, the difference between post-op and pre-op Kmax was not statistically significant post- and pre-operatively (47.48 vs 46.57 D; p=0.07).
Conclusion
LASEK followed by accelerated crosslinking provides excellent visual outcomes in early keratoconus patients that have previously undergone ICRS implantation. The long-term stability of these results will need to be confirmed in future studies.