One-Year Outcomes of Intracorneal Ring–Segment Insertion Assisted by Femtosecond Laser Simultaneously Performed with Corneal Collagen Cross-Linking for Treatment of Keratoconus

PURPOSE: To assess the results of simultaneously performed femtosecond laser–assisted Keraring intrastromal corneal ring–segment insertion and corneal collagen cross-linking for the treatment of keratoconus. PATIENTS AND METHODS: In this retrospective, noncomparative, interventional study, 30 eyes of 24 progressive-keratoconus patients of both sexes aged 18–36 years old with poor best-corrected visual acuity (BCVA) and intolerance to contact lenses were included. All patients had been subjected to complete preoperative and postoperative ophthalmological examinations — unaided VA, BCVA, refraction, Pentacam, and contrast sensitivity examinations at 3-month, 6-month, and 1-year follow-ups. RESULTS: Mean unaided VA had changed significantly from 0.649±0.239 logMAR preoperatively to 0.514±0.222 (P=0.014), 0.419±0.162 (P<0.001), and 0.379±0.142 (P<0.001) logMAR at the three follow-up visits, respectively. Mean BCVA had changed significantly from 0.326±0.144 logMAR preoperatively to 0.231±0.140 (P=0.006) at 1-year follow-up. Mean spherical equivalent refraction had decreased significantly at 6-month (P=0.0298) and 1-year follow-up (P=0.0081). Mean steep keratometry (K2) had also significantly reduced from 51.89±3.81 D to 49.87±4.57 D (P=0.034) at 6 months and 49.40±4.39 D (P=0.011) at 1 year. Mean refractive and keratometric astigmatism had significantly decreased at all follow-up visits. CONCLUSION: At 1-year follow-up, keraring intrastromal corneal ring–segment insertion assisted by femtosecond laser performed simultaneously with corneal collagen cross-linking resulted in an improvement in visual, refractive, and topographic outcomes, which may suggest it is an effective treatment of keratoconus.