Effect of treatment sequence in combined intrastromal corneal rings and corneal collagen crosslinking for keratoconus.
OBJECTIVE
To compare 2 sequences of combined intrastromal corneal ring segment (ICRS) implantation and ultraviolet/riboflavin-mediated corneal collagen crosslinking (CXL) in progressive keratoconus.


METHODS
Dunya Eye Hospital, Istanbul, Turkey.


METHODS
In this prospective comparative randomized consecutive study, CXL was followed by ICRS implantation (Group 1) or ICRS implantation was followed by CXL (Group 2). Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, spherical equivalent (SE), manifest cylinder (cylinder), and mean keratometry (K) were compared preoperatively and postoperatively.


RESULTS
The mean interval between treatments was 7 months +/- 2 (SD) (mean follow-up, 13 +/- 1 months). The mean UDVA and CDVA improved in both groups (UDVA: 0.07 +/- 0.09 to 0.25 +/- 0.12, Group 1, and 0.11 +/- 0.09 to 0.32 +/- 0.21, Group 2; CDVA: 0.24 +/- 0.11 to 0.41 +/- 0.20 and 0.22 +/- 0.16 to 0.55 +/- 0.2, respectively). The mean SE, cylinder, and mean K values decreased in both groups (SE: -7.13 +/- 3.34 D to -2.98 +/- 2.33 D, Group 1, and -7.05 +/- 5.54 D to -2.81 +/- 4.08 D, Group 2; cylinder: -4.38 +/- 2.03 D to -2.62 +/- 1.93 D and -4.68 +/- 2.60 D to -2.20 +/- 1.67 D, respectively; mean K: 52.47 +/- 4.01 D to 48.31 +/- 3.65 D and 52.06 +/- 4.93 D to 48.08 +/- 4.13 D, respectively). Overall, there was more improvement in CDVA, SE, and mean K in Group 2 than in Group 1.


CONCLUSIONS
Implantation of ICRS followed by CXL resulted in greater improvement of keratoconus.
Coskunseven
Efekan
E
Dunya Eye Hospital, Istanbul, Turkey.
Jankov
Mirko R
MR
Hafezi
Farhad
F
Atun
Serife
S
Arslan
Ebru
E
Kymionis
George D
GD
D000293:Adolescent; D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism* / Q000528:radiation effects / Q000601:surgery*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D008297:Male; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012256:Riboflavin / Q000627:therapeutic use; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity; D055815:Young Adult
D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin