Characterization of the effect of intracorneal ring segment in corneal ectasia after laser refractive surgery

Abstract

Purpose: To evaluate the visual, refractive, topographic, pachymetric, and biomechanical outcomes after intracorneal ring segment implantation in corneas with post-LASIK ectasia. Methods: Retrospective longitudinal study enrolling 26 eyes of 22 patients with post-LASIK ectasia and undergoing intracorneal ring segment implantation (KeraRing®, Mediphacos) using a 60-kHz femtosecond laser (IntraLase®, IntraLase Corp.) for corneal tunnelization. Visual, refractive, anterior, and posterior corneal topographic (Pentacam HR, Oculus), pachymetric, and corneal biomechanical changes (Ocular response Analyzer, Reichert) were evaluated during a 12-month follow-up. Vector analysis of astigmatic changes was performed. Results: A statistically significant reduction of sphere (p = 0.043) was observed at 1 month after surgery, with a significant improvement of uncorrected distance visual acuity associated (p = 0.019). Likewise, a significant reduction of anterior corneal power measurements (p ⩽ 0.014) and steepest posterior keratometric reading (p = 0.006) were observed at 1 month postoperatively, with no significant changes afterwards (p ⩾ 0.133). No significant changes were observed in manifest cylinder (p ⩾ 0.175), corrected distance visual acuity (p ⩾ 0.174), flattest posterior keratometric measurement (p ⩾ 0.282), volumetric measurements (p ⩾ 0.051), and corneal biomechanical parameters (p ⩾ 0.068). Vector analysis revealed an initial trend to overcorrection of astigmatism, with a trend to undercorrection at the end of follow-up and a significant variability in the outcome achieved in each patient. Conclusion: The implantation of KeraRing segments in post-LASIK corneal ectasia generates a significant modification of spherical refraction and a visual improvement due to a central corneal flattening generated. More refined nomograms of implantation in these cases should be developed to achieve a more predictable correction of astigmatism.