Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus.
OBJECTIVE
To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients.


METHODS
Retrospective interventional case series.


METHODS
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.


RESULTS
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.


CONCLUSIONS
ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.
Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Beirut Eye Specialist Hospital, Beirut, Lebanon.
Youssef
Y
Abdelmassih
Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Beirut Eye Specialist Hospital, Beirut, Lebanon.
Sylvain
S
El-Khoury
Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Beirut Eye Specialist Hospital, Beirut, Lebanon.
Ali
A
Dirani
Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Rafic
R
Antonios
Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Beirut Eye Specialist Hospital, Beirut, Lebanon.
Ali
A
Fadlallah
Beirut Eye Specialist Hospital, Beirut, Lebanon.
Carole G
CG
Cherfan
Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Elias
E
Chelala
Beirut Eye Specialist Hospital, Beirut, Lebanon; Mediclinic Dubai Mall, Dubai, United Arab Emirates. Electronic address: ejarade@yahoo.com.
Elias F
EF
Jarade
D000293:Adolescent; D002648:Child; D003319:Corneal Stroma / Q000473:pathology / Q000601:surgery*; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D012029:Refraction, Ocular; D012189:Retrospective Studies; D014792:Visual Acuity
D003432:Cross-Linking Reagents