Keratoconus Treatment Using Femtosecond Laser–Assisted Innovative Intracorneal Ring–Supported Graft Surgery: A Pilot Investigation

Abstract

Purpose: To investigate clinical manifestations and response to a revision in the intrastromal corneal ring and implantation technique for the treatment of severe keratoconus at two private clinics in Iran. Methods: This prospective, non-comparative clinical study included 6 eyes from 6 patients treated with a new innovative sutureless ring-supported graft insertion technique. Refractive, topographic, corneal biomechanical, and anterior aberrometry outcomes were analyzed during the 6-month follow-up. Secondary variables included corneal stiffness and confocal microscopy. Results: No intraoperative and postoperative complications occurred. Six months after implantation of the RinGraft, the ring was centered at the pupil reflex, the eye was white and quiet, and the graft was clear. The mean topographic keratometry values decreased significantly postoperatively ( P = .025). Additionally, corneal stiffness increased significantly postoperatively ( P = .004). Anterior and posterior corneal aberrometry data collected over a 5-mm diameter revealed a significant decrease in higher order aberrations, spherical aberration, primary coma, and trefoil 6 months after surgery ( P = .019). Intraocular pressure changes were significantly greater than before surgery ( P = .006). Uncorrected distance visual acuity increased from 0.96 ± 0.52 logMAR preoperatively to 0.71 ± 0.22 logMAR postoperatively ( P = .078). No statistically significant change was found in corrected distance visual acuity ( P = .0221) Conclusions: Excellent structural support and stability of the cornea were observed immediately postoperatively and 6 months after RinGraft insertion. Considering the corneal instability and asymmetry, it appears to be a possible and safe therapy option for keratoconic eyes that can be performed easily. [ Journal of Refractive Surgery Case Reports. 2024;4(1):e1–e10.]