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Procedure order may affect results with cross-linking, intrastromal corneal ring placement

J Cataract Refract Surg. 2009;35(12):2084-2091.

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Sequencing of intrastromal corneal ring placement and corneal cross-linking may be an important determining factor in improvement of keratoconus and visual acuity.

In a study of 48 eyes of 43 patients, uncorrected and corrected distance visual acuity improved, and mean spherical equivalent, cylinder and keratometry values decreased, regardless of whether an intrastromal corneal ring was placed before or after a corneal cross-linking procedure.

However, there were statistically significant differences in postop values among patients who underwent corneal cross-linking followed by implantation of an intrastromal corneal ring (group 1) compared with patients who had a ring placed before corneal cross-linking treatment (group 2).

Corrected distance visual acuity improved from a mean 0.24 to 0.41 after both procedures in group 1, but from a mean 0.22 to 0.55 in group 2. Mean cylinder decreased from –4.38 D to -2.62 D in group 1 compared with a decrease from –4.68 D to –2.20 D in group 2.