title: Intracorneal ring segments implantation followed by same-day photorefractive keratectomy and corneal collagen cross-linking in keratoconus.
abstract: OBJECTIVE
  To evaluate the efficacy of intrastromal corneal ring segments implantation followed by same-day photorefractive keratectomy (PRK) and ultraviolet-A/riboflavin collagen cross-linking (CXL) in patients with keratoconus.
  
  
  METHODS
  Four patients (five eyes) were included in the study. All patients first underwent femtosecond laser-enabled placement of intracorneal ring segments (Intacs, Addition Technology). Uncorrected (UDVA) and corrected distance visual acuity (CDVA) and keratometry readings remained stable for 6 months. Same-day PRK and CXL were subsequently performed in all patients.
  
  
  RESULTS
  Six months after Intacs plus PRK/CXL, significant improvements were noted for UDVA, CDVA, spherical equivalent refraction, keratometry, and total aberrations. No patient lost lines of CDVA or developed haze.
  
  
  CONCLUSIONS
  The combination of intracorneal ring segments implantation followed by sequential same-day PRK/CXL may be a reasonable option for improving visual acuity in select patients with keratoconus.
authors.affiliation: Yonge Eglinton Laser Eye Center, University Health Network, Toronto, Ontario, Canada. alfonsoiovieno@hotmail.com
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iovieno
authors.forename: Marie Eve
authors.initials: ME
authors.lastname: Légaré
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Rootman
authors.forename: Sonia N
authors.initials: SN
authors.lastname: Yeung
authors.forename: Peter
authors.initials: P
authors.lastname: Kim
authors.forename: David S
authors.initials: DS
authors.lastname: Rootman
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism / Q000601:surgery*; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D054018:Lasers, Excimer / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012256:Riboflavin / Q000627:therapeutic use; D016896:Treatment Outcome; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin