Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus

To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients. Retrospective interventional case series. This retrospective study included pediatric patients (aged ≤14 years) with keratoconus and poor corrected...

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Bibliographic Details
Published in:American journal of ophthalmology 2017-06, Vol.178, p.51-57
Main Authors: Abdelmassih, Youssef, el-Khoury, Sylvain, Dirani, Ali, Antonios, Rafic, Fadlallah, Ali, Cherfan, Carole G., Chelala, Elias, Jarade, Elias F.
Format: Article
Language:English
Subjects:
Adolescent
Age
Cataracts
Child
Collagen
Corneal Stroma - pathology
Corneal Stroma - surgery
Corneal Topography
Cross-Linking Reagents - pharmacology
Feasibility studies
Female
Follow-Up Studies
Humans
Keratoconus - diagnosis
Keratoconus - physiopathology
Keratoconus - therapy
Male
Ophthalmologic Surgical Procedures - methods
Patients
Pediatrics
Prostheses and Implants
Prosthesis Design
Prosthesis Implantation - methods
Refraction, Ocular
Retrospective Studies
Surgeons
Surgery
Visual Acuity
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Summary:To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients. Retrospective interventional case series. This retrospective study included pediatric patients (aged ≤14 years) with keratoconus and poor corrected distance visual acuity (CDVA) that underwent ICRS implantation and cross-linking (CXL). ICRS were inserted under topical anesthesia after creating a corneal tunnel with a femtosecond laser. Cross-linking was performed 1 month subsequently. Records were reviewed and data collected preoperatively and at 6 months, 1 year, 2 years, and 4 years postoperatively. Twelve patients (17 eyes; 10 male, 2 female) aged 9–14 years (mean age 12.3 years) received ICRS implantation followed by CXL. Follow-up times ranged from 6 months to 4 years after surgery. At the 6-month follow-up all eyes were evaluated; at the 1-year, 2-year, and 4-year follow-up 11, 10, and 7 eyes were evaluated, respectively. At the 6-month follow-up, mean CDVA in comparison to preoperative levels improved significantly (P = .001) from 0.30 ± 0.19 logMAR to 0.12 ± 0.1 logMAR; mean uncorrected distance visual acuity (UDVA) also improved significantly from 0.90 ± 0.50 logMAR to 0.43 ± 0.31 logMAR. A significant decrease in both keratometry readings and spherical equivalent (from −4.0 to −1.56 diopters) was also noted after ICRS insertion. At the 1-year, 2-year, and 4-year follow-up refractive values remained relatively stable in comparison to the 6-month follow-up, except for a minor but significant improvement in cylinder and, at 4 years, in UDVA. All patients tolerated the surgery well and no intraoperative or postoperative complications were reported, except for 1 ring segment that had to be removed after 2 years owing to vascularization and corneal thinning. ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.
ISSN:0002-9394
1879-1891
DOI:10.1016/j.ajo.2017.03.016