Seven-year follow-up of a novel 360-degree implant (annular intracorneal inlay) plus accelerated corneal cross-linking: A case study

to report late visual, refractive, and tomographic findings of a patient with progressive keratoconus (KCN) over 7-year follow-up examinations after treatment with an advanced intrastromal implant known as annular intracorneal inlay (AICI) combined with accelerated corneal cross-linking (ACXL).

Slit-lamp photography of anterior segment, corneal tomography maps, and manifest refractions were recorded.

A 30-year-old female presented with the complaint of gradual decreased visual acuity in recent years that was remarkable in her left eye (LE). After clinical examinations, she underwent AICI implantation plus ACXL on her LE. Seven years later, notable improvements were observed in some visual, refractive, and tomographic parameters. The most obvious change was ascribed to the uncorrected distance visual acuity (UDVA) that was 1.3logMAR and 0.4logMAR, before and 7 years after the operation, respectively. However, the preoperative corrected distance visual acuity (CDVA) improved slightly from 0.3logMAR to 0.22logMAR after 7 years. The values of anterior K-max, mean-K, flat-K, and steep-K were flattened by 1.80 D, 1.10 D, 1.00 D, and 1.30 D, respectively. Most visual, refractive, and tomographic data improved or remained stable after 7 years and no remarkable ocular complication was observed at the end of the 7^th year.

AICI implantation plus ACXL could be considered as a safe and effective strategy in halting the KCN progression and improving the visual and tomographic properties of the KCN patients. However, future prospective studies with more participants are needed to evaluate the potential effect of AICI implantation on KCN progression.