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Safety and Efficacy of Sequential Intracorneal Ring Segment Implantation and Cross-linking in Pediatric Keratoconus
Youssef Abdelmassih1, Sylvain El-Khoury1, Ali Dirani1
1Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; Beirut Eye Specialist Hospital, Beirut, Lebanon.
Insights
Intracorneal ring segments (ICRS) followed by cross-linking significantly improve vision in pediatric keratoconus patients. This safe procedure offers effective visual rehabilitation for children with poor vision.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Pediatric Eye Care
Background:
- Pediatric keratoconus often leads to progressive vision loss.
- Intracorneal ring segments (ICRS) and cross-linking (CXL) are potential treatments.
Purpose of the Study:
- To assess the safety and visual outcomes of ICRS implantation combined with CXL in pediatric keratoconus patients.
- Evaluate the long-term efficacy of this combined treatment approach.
Main Methods:
- Retrospective interventional case series involving pediatric patients (≤14 years) with keratoconus and poor corrected distance visual acuity (CDVA).
- ICRS implantation using femtosecond laser followed by CXL one month later.
- Data collected preoperatively and at 6 months, 1, 2, and 4 years postoperatively.
Main Results:
- Significant improvements in CDVA and uncorrected distance visual acuity (UDVA) were observed at 6 months post-surgery.
- Keratometry readings and spherical equivalent showed significant reductions.
- Visual and refractive outcomes remained relatively stable up to 4 years, with minor improvements in cylinder and UDVA.
Conclusions:
- ICRS implantation followed by CXL is a safe and effective treatment for visual rehabilitation in pediatric keratoconus patients.
- The combined procedure demonstrates good tolerability and a low complication rate.
Purpose:
To evaluate the safety and visual outcome of intracorneal ring segment (ICRS) implantation followed by cross-linking in pediatric keratoconus patients.
Design:
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.
Conclusion:
ICRS implantation is a safe and effective procedure for visual rehabilitation in children with keratoconus and poor CDVA.
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