Same-Day Intrastromal Corneal Ring Segment and Collagen Cross-Linking for Ectasia After Laser in Situ Keratomileusis: Long-Term Results

Abstract

PURPOSE: To report the long-term results of combined same-day intrastromal corneal ring segment placement and corneal collagen cross-linking (CXL) for postoperative laser in situ keratomileusis (LASIK) ectasia. DESIGN: Retrospective, interventional case series. METHOD: This retrospective, interventional cases series was performed in Turkiye Hospital Eye Clinic and the Department of Ophthalmology, Fatih University Medical Faculty Hospital, Istanbul, Turkey. Sixteen eyes of 14 patients with postoperative ectasia after LASIK were enrolled. All consecutive patients were treated with femtosecond laser-assisted intrastromal corneal ring segment implantation and followed by same-day corneal collagen cross-linking for ectasia occurring after LASIK. Main outcome measures included uncorrected distance visual acuity, corrected distance visual acuity, spherical and cylindrical refraction, and simulated keratometry values. RESULTS: The mean age +/- standard deviation of the 10 women and 4 men was 33.0 +/- 6.5 years (range, 23 to 44 years), and the mean follow-up was 43 months (range, 36 to 62 months). The uncorrected distance visual acuity improved significantly from 1.18 +/- 0.42 logarithm of the minimal angle of resolution (logMAR) units to 0.44 +/- 0.22 logMAR (P < .001), and the corrected distance visual acuity improved significantly from 0.46 +/- 0.26 logMAR to 0.21 +/- 0.14 logMAR (P < .001). The mean spherical and cylindrical refraction decreased significantly (P < .001 for both). The maximum keratometry value decreased from baseline by 49.3 +/- 4.9 diopters (D) to 43.9 +/- 2.8 D at the last visit, and the minimum keratometry value decreased from 44.3 +/- 4.7 D to 41.5 +/- 3.5 D (P < .001 for both). No serious complications were shown during follow-up. CONCLUSIONS: Implantation of intrastromal corneal ring segment implantation combined with same-day corneal collagen cross-linking was a safe and effective treatment for ectasia occurring after LASIK. It also significantly improved the visual acuity, refraction, and keratometry values. (C) 2014 by Elsevier Inc. All rights reserved.