Refractive, Topographic, and Visual Outcomes of Same-Day Corneal Cross-Linking With Ferrara Intracorneal Ring Segments in Patients With Progressive Keratoconus

Purpose: To report refractive, topographic, and visual outcomes 12 months after same-day treatment with corneal cross-linking (CXL) and Ferrara intracorneal ring segments (ICRS) in eyes with progressive keratoconus (KC) and contact lens intolerance. Methods: This was a case series of 7 eyes (7 patients) with progressive mild to moderate keratoconus and contact lens intolerance undergoing implantation of Ferrara ICRS immediately followed by corneal cross-linking. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive error, pachymetry, and keratometry were evaluated at 3, 6, and 12 months of follow-up. Results: Mean follow-up was 11.7 +/- 3.6 months (range, 5-17 months). Mean preoperative UCVA and BSCVA were 0.10 +/- 0.07 (range, 0.05-0.2) and 0.56 +/- 0.08 (range, 0.5-0.7), respectively. One year after the treatment, mean UCVA and BSCVA measured 0.60 +/- 0.24 (range, 0.32-0.9) and 0.82 +/- 0.25 (range, 0.5-1.2), respectively. The mean spherical equivalent decreased significantly (P < 0.05) with 3.5 diopters (D). Mean K values (average keratometry of the cornea) decreased from 46.81 +/- 2.13 D (range, 44-51 D) to 43.97 +/- 2.22 D (range, 42-47.5 D) 1 year after the treatment. The average preoperative thinnest pachymetry measured 462 +/- 46 mu m (range, 410 +/- 546 mu m) and did not change significantly after the treatment. In patient 1, the inferior ICRS was removed 5 months postoperatively because of implant migration. Conclusions : The combined treatment of corneal cross-linking and Ferrara ICRS is a safe procedure that may be considered in patients with progressive mild to moderate KC and contact lens intolerance.