Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications

To examine the clinical outcomes, predictors of visual improvement and complications of continuous intracorneal ring (ICCR) implantation in patients with keratoconus and confirmed contact-lens intolerance (CLI).

This nonrandomized, multi-centric, retrospective cohort study examined visual, keratometric and clinical outcomes evaluated after a minimum follow-up of 2 months. Among the inclusion criteria for the standard treatment group (STG) were corrected distance visual acuity (CDVA) <20/25 Snellen, no central corneal scars, minimum corneal thickness >350µm, and central mean keratometry reading (meanK) <55 diopters. All other eyes were classified as non-standard treatment group.

A total of 118 eyes of 118 patients with aged 32 ± 11 years were included in this study. At a median follow-up of 161 days (interquartile range: 111-372 days) ICCR implantation improved the CDVA from a mean of 0.38 to 0.15 logMAR (p<0.0001). Our correlation analysis showed lower preoperative CDVA to be the single best predictor of CDVA improvement, with eyes of a CDVA of 20/80 or lower improving by 4.3 ± 2.0 lines on average. Eyes with a meanK >55 diopters gained 9.04±4.83 lines in UDVA and 2.86±3.09 lines in CDVA. However, postoperatively these eyes had a CDVA of 0.32±0.21 logMAR which is significantly inferior to the STG outcome (p=0.001372). Fifteen eyes (12.7%) had to undergo a ring exchange procedure because of refractive under- (9 eyes) or overcorrection (6 eyes). Two eyes (1.7%) experienced medical complications.

This study confirms the inclusion criteria of ICCR implantation in KC eyes with CDVA <20/25 and CLI. Particularly in eyes with a preoperative CDVA <20/80 and a meanK <55 diopters, ICCR implantation should be considered due to its reversibility and low rates of serious complications. The main challenge remains in the low predictability of the magnitude of this improvement in eyes with CDVA >20/30.