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Published on: November 12, 2015
Intracorneal Ring Segment Implantation with Epithelium-off Accelerated Cross-Linking for Pediatric Keratoconus: A
Roberto Albertazzi1, Camila Solis1, Antonio Ballesteros-Sánchez2
1Centro de Ojos Quilmes, Buenos Aires 1865, Argentina.
Insights
Intracorneal ring segments (ICRS) combined with epithelium-off accelerated cross-linking (epi-off A-CXL) effectively treat pediatric keratoconus (KC). This combination therapy offers sustained improvements in vision and corneal shape, halting long-term disease progression.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Vision Science
Background:
- Pediatric keratoconus (KC) is a progressive corneal ectasia leading to visual impairment.
- Current treatments aim to halt progression and improve visual acuity.
- Intracorneal ring segments (ICRS) and accelerated cross-linking (A-CXL) are established interventions.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of combining ICRS implantation with epithelium-off accelerated cross-linking (epi-off A-CXL) in pediatric KC patients.
- To assess the efficacy of this combined approach in improving visual acuity, refractive error, and corneal topography.
- To determine the durability of treatment effects over an extended follow-up period.
Main Methods:
- A retrospective, longitudinal study was conducted involving 73 eyes of pediatric KC patients.
- Patients underwent ICRS implantation followed by epi-off A-CXL.
- Outcome measures included visual acuity (UDVA, CDVA), refraction (SE), keratometry (Km, K1, K2), and astigmatism (refractive and corneal).
- Data were analyzed at 12, 36, 60, and 84 months post-procedure using astigmatism vector analysis.
Main Results:
- Significant improvements in uncorrected and corrected distance visual acuity were observed throughout the follow-up period.
- Mean keratometry (Km) and steepest corneal curvature (K2) showed significant reductions, indicating corneal flattening.
- Both refractive and corneal astigmatism demonstrated significant improvements, as evidenced by changes in vector analysis parameters.
- These positive visual and keratometric changes were sustained up to 84 months.
Conclusions:
- The combination of ICRS implantation and epi-off A-CXL is an effective therapeutic strategy for pediatric KC.
- This treatment provides sustained improvements in visual function, corneal curvature, and astigmatism.
- The findings support this combined approach as a comprehensive option for managing pediatric KC, halting progression, and enhancing visual outcomes.
Purpose:
To evaluate long-term clinical outcomes after intracorneal ring segment implantation (ICRS) followed epithelium-off (epi-off) accelerated cross-linking (A-CXL) in pediatric keratoconus (KC).
Setting:
Centro de Ojos Quilmes, Argentina.
Design:
Longitudinal Retrospective study.
Methods:
Seventy-three eyes from pediatric KC patients were included. Outcome measures included uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical refraction, spherical equivalent (SE), mean keratometry (Km) with the flattest (K1) and steepest (K2) corneal curvatures, and both refractive and corneal astigmatism. Changes from preoperative were assessed at 12, 36, 60, and 84 months. Astigmatism vector analysis was performed using double-angle plots, reporting centroids and mean absolute values.
Results:
Throughout the follow-up period, significant improvements were observed in visual and keratometric outcomes compared with preoperative values. At 60 months, UDVA and CDVA improved by 0.29 logMAR (P < 0.0001; 95% CI, 0.13 to 0.45) and 0.15 logMAR (P < 0.0001; 95% CI, 0.05 to 0.27), respectively. Km decreased by 2.74 D at 60 months (P = 0.022; 95% CI, 0.24 to 5.24), whereas K2 decreased by 4.01 D at 84 months (P = 0.003; 95% CI, 0.96 to 7.05). Changes in centroids and mean absolute values for both corneal and refractive astigmatism also remained significant during the follow-up.
Conclusion:
ICRS combined with epi-off A-CXL represents an effective treatment for pediatric KC, providing sustained improvements in visual acuity, keratometry, and both refractive and corneal astigmatism over the follow-up period. These findings support its role as a comprehensive therapeutic approach to halt long-term disease progression and enhance visual function.
