Results of Follow-up in Pediatric Keratoconus Treated With Intracorneal Ring Segments Implantation Alone or in Combination With Corneal Cross-linking

Abstract

Purpose: To report visual and topographic outcomes of pediatric keratoconus with intracorneal ring segments (ICRS) implantation alone or in combination with accelerated corneal cross-linking (A-CXL).

Methods: A descriptive, retrospective observational study was performed. Medical records of patients younger than 18 years at Fundación Oftalmológica Nacional in Bogotá, Colombia, were reviewed. Demographic data, follow-up time, preoperative and postoperative uncorrected (UCVA) and best corrected (BCVA) visual acuity, manifest refraction, and tomography were evaluated. SPSS software (version 22.0; SPSS, Inc) was used for analysis.

Results: Twenty-six eyes of 19 patients with a mean age of 16.5 ± 1.8 years were analyzed, and 16 were boys (84.2%). Median follow-up time was 39.6 months (inter-quartile range [IQR] = 30). Fifteen patients (78.9%) had a history of allergic conjunctivitis. Sixteen eyes (61.5%) received ICRS implantation with A-CXL and 10 eyes (38.4%) received ICRS implantation only. Global results (including ICRS implantation with A-CXL and ICRS implantation only) were: (1) median UCVA of 0.90 logarithm of the minimum angle of resolution (logMAR) (IQR = 0.85) preoperatively improved to 0.54 logMAR (IQR = 0.70) postoperatively; (2) median BCVA of 0.43 logMAR (IQR = 0.39) preoperatively improved to 0.30 logMAR (IQR = 0.26) postoperatively; and (3) median spherical equivalent of -5.37 diopters (D) (IQR = -5.28) preoperatively improved to -4.12 D (IQR = -3.57) postoperatively. There was a reduction in half of the sphere and cylinder. The median maximum keratometry was 54.40 D (IQR = 7.4) preoperatively and 49.80 D (IQR = 5.3) postoperatively. The median asphericity was -1.18 (IQR = 0.70) preoperatively and changed to -0.75 (IQR = 0.68) postoperatively. No patient presented with complications before or after surgery.

Conclusions: ICRS implantation only or in combination with A-CXL induced visual and topographic improvement in patients with keratoconus, which was maintained throughout the follow-up time. It seems to be a safe procedure to delay or avoid corneal transplantation in the pediatric population. [J Pediatr Ophthalmol Strabismus. 2022;59(2):118-127.].