Investigation of the efficiency of intrastromal ring segments with cross-linking using different sequence and timing for keratoconus

· AIM: To evaluate and compare the efficacy and stability of intrastromal corneal ring segment(ICRs)implantation with cross-linking(CXL) using different sequence and timing.· METHODS: In this single retrospective study, 86 keratoconic eyes subjected the ICRs implantation. We analyzed only 41 eyes that had complete follow-ups.They were divided into three groups: ICRs implantation was applied only(group normal), ICRs first followed by CXL immediately(group CXL-S), CXL first followed by ICRs long after(group CXL-B). The visual acuity,refractive results, keratometry were compared preoperatively and 1y postoperatively. Their differences among the three groups were also analyzed.·RESULTS: Group normal comprised 25 eyes, group CXL-S 8 eyes, and group CXL-B 8 eyes. There were improvements in the mean uncorrected distance visual acuity(UDVA) and the mean corrected distance visual acuity(CDVA) compared preoperatively and 1y postoperatively [UDVA: 0.31(P =0.030) logarithmic minimum angle of resolution(log MAR) group normal, 0.4(P =0.020) group CXL-S, 0.45(P =0.001) group CXL-B;CDVA : 0. 21 log MAR( P = 0. 013) group normal, 0. 30(P =0.036) group CXL-S; 0.26(P =0.000) group CXL-B].The refractive and topographic outcomes also showed improvements. In terms of comparisons among the three groups, all the P values were above 0.05, showing no significant difference. But only group CXL-B had improvement in UDVA and CDVA for all the patients.·CONCLUSION: With safety and good visual outcomes,ICRs implantation is a viable alternative for keratoconus.No significant difference was found among these three groups.