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Combination of cross-linking, intracorneal ring implantation shows positive, synergistic effects
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PARIS — The combination of collagen cross-linking, or CXL, and intracorneal rings, or ICRs, has a synergistic effect on keratoconus, leading to enhanced visual results and stability, according to a study.
"We don't know for sure whether ICRs halt the progression of the disease, but CXL certainly does. On the other hand, ICRs have been shown to reduce corneal abnormalities by flattening the ectasia in 80% of the cases, and cross-linking can contribute to this effect. Although it has not been demonstrated, the two techniques together might improve corneal biomechanics and certainly lead to better corneal topography," David Touboul, MD, said at the meeting of the French Society of Ophthalmology.
Collagen cross-linking and intracorneal rings have complementary effects on the ectatic cornea. Cross-linking produces modifications of the anterior cornea, while the posterior fibers are unaffected. This is even more true with the transepithelial approach. A demarcation line is visible on anterior chamber optical coherence tomography, indicating a different gradient of elasticity between the anterior and posterior layers.
"If we look at the cornea when it's treated with both procedures simultaneously, this demarcation line is no longer visible," Dr. Touboul said.
The effects of simultaneous treatment with cross-linking and intracorneal rings, some Intacs (Addition Technology) and some Ferrara (Ferrara Ophthalmics), were shown in a preliminary study of 34 eyes with keratoconus, mostly stage 2 or 3. The mean follow-up was 5 months.
"We could see interesting topographical changes. All eyes gained two to three BCVA lines. Myopia decreased by about 4.5 D. The [maximum corneal curvature] was about 4 D less compared to preop. Pachymetry was stable. Disease progression was halted in all cases," Dr. Touboul said.
One case of superficial abscess was reported at 1 month, and extrusion occurred in one case at 1 year.
"We need randomized studies to compare the results of the two separate vs. combined procedures and to establish whether the two techniques are better performed simultaneously or sequentially," he said.
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