Related Experiment Video
Updated: Jun 21, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
Intracorneal ring segment implantation with epithelium-off accelerated crosslinking for pediatric keratoconus: 7-year
Roberto Albertazzi1, Camila Solis, Antonio Ballesteros-Sánchez
1From the Centro de Ojos Quilmes, Buenos Aires, Argentina (Albertazzi, Solis); Department of Physics of Condensed Matter, Optics Area, University of Seville, Seville, Spain (Ballesteros-Sánchez); Department of Medicine and Surgery, Ophthalmology Unit, Faculty of Medicine and Surgery, University Kore of Enna, Enna, Italy (Mazzotta); Siena Crosslinking Center, Siena, Italy (Mazzotta); Department of Ophthalmology, VITHAS Almería Hospital, Qvision, Almeria, Spain (Rocha-de-Lossada); Department of Ophthalmology, Regional Universitary Hospital of Málaga, Granada, Spain (Rocha-de-Lossada); Department of Surgery, Ophthalmology Area, University of Seville, Seville, Spain (Rocha-de-Lossada); Department of Opthalmology, Vithas Malaga, Malaga, Spain (Rocha-de-Lossada).
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 by epithelium-off (epi-off) accelerated crosslinking (A-CXL) in pediatric keratoconus (KC).
Setting:
Centro de Ojos Quilmes, Buenos Aires, Argentina.
Design:
Longitudinal retrospective study.
Methods:
73 eyes from patients with pediatric KC were included. Outcome measures included uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical refraction, spherical equivalent (SE), mean keratometry (K m ) with the flattest and steepest (K 2 ) corneal curvatures, and both refractive and corneal astigmatism. Changes from preoperative were assessed at 12 months, 36 months, 60 months, 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 < .0001; 95% CI, 0.13-0.45) and 0.15 logMAR ( P < .0001; 95% CI, 0.05-0.27), respectively. K m decreased by 2.74 diopters (D) at 60 months ( P = .022; 95% CI, 0.24-5.24), whereas K 2 decreased by 4.01 D at 84 months ( P = .003; 95% CI, 0.96-7.05). Changes in centroids and mean absolute values for both corneal and refractive astigmatism also remained significant during the follow-up.
Conclusions:
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.
