Intrastromal corneal ring segments in previously cross-linked vs virgin keratoconic corneas: multiparameter...

To compare outcomes of intrastromal corneal ring segments (ICRS) insertion in crosslinked (CXL) vs non-CXL keratoconic eyes, using a multiparameter propensity score matching (PSM).

American University of Beirut Medical Center, Beirut, Lebanon.

Retrospective case series.

198 eyes with mild to moderate keratoconus who underwent ICRS insertion were included. Our data were divided into 2 groups, based on whether CXL was performed before ICRS insertion. A PSM was used to balance the following covariates: age, sex, ICRS segment thickness, arc size, optical zone, topographic data, and total corneal coma. Visual, refractive, topographic, and total corneal aberrometric data were measured preoperatively and at 6-month post-ICRS implantation.

After 1:1 PSM, 32 eyes from 27 patients with prior CXL were matched to 32 untreated eyes from 30 patients. Preoperative parameters were not statistically different between the groups ( P s > .05). Both groups displayed a statistically significant improvement in visual, refractive, topographic (simulated keratometry, maximum axial keratometry, and keratometric astigmatism) and total corneal aberrometric (total higher-order aberrations and coma) outcomes 6 months after ICRS insertion (all P s < .05). The changes in all reported visual, refractive, topographic, and total corneal aberrometric outcomes were not statistically different between CXL and non-CXL eyes (all P s > .05).

When properly matched for preoperative disease type and severity, ICRS insertion had a similar improvement in eyes with and without CXL.