Iris Publishers- Open access Journal of Ophthalmology & Vision Research | Combined Intracorneal Ring Segments and Corneal- Collagen Crosslinking

Authored by Karolinne Maia Rocha

Keratoconus (KCN) is a bilateral, progressive, non-inflammatory corneal disease of which etiology is not completely understood. If left untreated, it may lead to significant visual impairment due to irregular astigmatism. Corneal crosslinking (CXL) is currently the only treatment option that halts the progression of the disease and may help avoid corneal transplantation. Although it may not improve visual acuity (VA), CXL can be combined with refractive procedures such as intracorneal ring segment (ICRS) implantation to achieve a better postoperative outcome. The sequence of treatment is a cause of discussion. Some believe sequence is not important with halted progression and improvement in refractive outcome achieved regardless, while different studies have shown the superiority of ICRS implantation followed by either concurrent of sequential CXL.

Keratoconus is an asymmetric, progressive disease in which the cornea assumes a conical shape and usually presents with progressive non-inflammatory stromal thinning and irregular astigmatism, which in turn reduces quality of vision [1,2].
The only available treatment to halt the progression of KCN is CXL [3]. Furthermore, it is a procedure that could avoid the necessity of corneal transplantation such as lamellar or penetrating keratoplasty [4]. To halt progression, CXL uses ultraviolet A (UVA) and vitamin B2 (Riboflavin) to strengthen the corneal stroma collagen bonds and make it less flexible and elastic [3,5]. ICRS on the other hand, improve visual acuity in patients intolerant to contact lenses by inducing flattening of the cornea, which improves corneal astigmatism and myopia [3-6].
Several studies have been published on the effects and safety of CXL PLUS (CXL combined with a refractive procedure, usually ICRS) [4-8] on refractive outcomes, VA, and corneal topography. It is hypothesized that CXL induces an additional flattening in corneas with ICRS, which in turn produces a superior effect in visual outcome [9]. The purpose of this article is to quickly review the aspects of combined corneal crosslinking and intracorneal ring segments implantation to stop progression of keratoconus.

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