title: Refractive and topographic results of transepithelial cross-linking treatment in eyes with intacs.
abstract: OBJECTIVE
  To evaluate the efficacy of transepithelial cross-linking (CXL) in keratoconic eyes after Intacs implantation.
  
  
  METHODS
  Twenty-five eyes of 17 patients with bilateral keratoconus underwent Intacs implantation with subsequent cross-linking (CXL) treatment. Inclusion criteria were absence of corneal scarring, contact lens intolerance, corneal thickness higher than 400 mum, and endothelial cell density more than 3000 per square millimeter. Preoperative and 3-month-postoperative uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refractions, and mean and steepest keratometric (K) values were reviewed retrospectively. The results in Intacs group were compared with those obtained after CXL/Intacs.
  
  
  RESULTS
  There were 10 males and 5 females; mean age was 25.14 +/- 7.11 (range 16-39) years old. Mean time between implantation of Intacs and CXL was 3.98 months. CXL after Intacs resulted in an additional improvement in UCVA, BCVA, sphere, cylinder, and keratometry. Intacs resulted in an improvement of 1.9 Snellen lines (P < 0.05) of UCVA and 1.7 Snellen lines (P < 0.05) of BCVA. CXL performed after Intacs treatment yielded an additional 1.2 Snellen lines (P < 0.05) of UCVA and 0.36 Snellen lines (P < 0.05) of BCVA. The decrease in spherical, cylindrical, mean K, and steepest K values was 2.08 diopters (D) (P < 0.05), 0.47 D (P > 0.05), 2.22 D (P < 0.05), and 1.27 D (P < 0.05), respectively, after Intacs treatment with an additional 0.5 D (P < 0.05), 0.15 D (P > 0.05), 0.35 D (P > 0.05), and 0.76 D (P < 0.05) of improvement gained after CXL in each respective parameter.
  
  
  CONCLUSIONS
  Intacs implantation with transepithelial CXL is effective in eyes with keratoconus. Collagen cross-linking has an additive effect on Intacs implantation in these eyes and may be considered as an enhancement/stabilizing procedure.
authors: Department of Cataract and Refractive Surgery, Kudret Eye Hospital, Kavaklidere, Ankara, Turkey 06660. aylinclzy@gmail.com
authors: Aylin
authors: A
authors: Ertan
authors: Hümeyra
authors: H
authors: Karacal
authors: Günhal
authors: G
authors: Kamburoğlu
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism* / Q000601:surgery; D019781:Corneal Topography; D004728:Endothelium, Corneal / Q000473:pathology; D019573:Epithelium, Corneal / Q000378:metabolism; D005260:Female; D005486:Flavin Mononucleotide / Q000627:therapeutic use; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012029:Refraction, Ocular / Q000502:physiology*; D019233:Retreatment; D012189:Retrospective Studies; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D017319:Photosensitizing Agents; D005486:Flavin Mononucleotide; D003094:Collagen