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Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis

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Corneal Allogeneic Intrastromal Ring Segments for Treating Keratoconus-Systematic Review and Meta-Analysis.

Eline Elodie Barbara De Clerck^1,2, Johann Krüger³, Martina Kropp^1,2

¹Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland.

Medicina (Kaunas, Lithuania)

|March 28, 2026

Summary

Corneal allogeneic intrastromal ring segments (CAIRS) implantation effectively improves vision and reduces corneal steepness in keratoconus patients. Different surgical techniques for CAIRS preparation and the addition of corneal cross-linking did not show significant differences in outcomes.

Keywords:

corneal allogeneic intrastromal ring segments implantation keratoconus

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Area of Science:

Ophthalmology
Corneal Surgery
Vision Science

Background:

Keratoconus is a progressive condition causing corneal ectasia and vision impairment.
Corneal allogeneic intrastromal ring segments (CAIRS) are used to manage keratoconus.
Evaluating CAIRS preparation techniques and adjunctive corneal cross-linking is crucial.

Purpose of the Study:

To systematically review and meta-analyze the effectiveness of CAIRS implantation for keratoconus.
To compare different surgical techniques for CAIRS preparation.
To assess the impact of adjunctive corneal cross-linking on CAIRS outcomes.

Main Methods:

Systematic review and meta-analysis following PRISMA guidelines.
Comprehensive literature search across Embase, Medline, and Cochrane.
Inclusion of 18 studies with 567 eyes from 459 patients.

Main Results:

CAIRS implantation significantly improved uncorrected and best-corrected visual acuity at 1 month and 1 year postoperatively.
Significant reductions in mean and maximum keratometry were observed at 1 month and sustained at 1 year.
No significant differences in surgical outcomes were found between different CAIRS preparation techniques or with adjunctive corneal cross-linking.

Conclusions:

CAIRS implantation is an effective treatment for keratoconus, enhancing visual acuity and reducing corneal curvature.
Surgical technique for CAIRS preparation and the use of corneal cross-linking do not appear to significantly alter outcomes.
CAIRS offers a viable option for keratoconus management regardless of specific preparation methods.