Intracorneal Ring Segment Implantation with Epithelium-off Accelerated Cross-Linking for Pediatric Keratoconus: A 7-Year Retrospective Analysis

Purpose: To evaluate long-term clinical outcomes after intracorneal ring segment implantation (ICRS) followed epithelium-off (epi-off) accelerated cross-linking (A-CXL) in pediatric keratoconus (KC). Setting: Centro de Ojos Quilmes, Argentina. Design: Longitudinal Retrospective study. Methods: Seventy-three eyes from pediatric KC patients were included. Outcome measures included uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical refraction, spherical equivalent (SE), mean keratometry (Km) with the flattest (K1) and steepest (K2) corneal curvatures, and both refractive and corneal astigmatism. Changes from preoperative were assessed at 12, 36, 60, and 84 months. Astigmatism vector analysis was performed using double-angle plots, reporting centroids and mean absolute values. Results: Throughout the follow-up period, significant improvements were observed in visual and keratometric outcomes compared with preoperative values. At 60 months, UDVA and CDVA improved by 0.29 logMAR (P < 0.0001; 95% CI, 0.13 to 0.45) and 0.15 logMAR (P < 0.0001; 95% CI, 0.05 to 0.27), respectively. Km decreased by 2.74 D at 60 months (P = 0.022; 95% CI, 0.24 to 5.24), whereas K2 decreased by 4.01 D at 84 months (P = 0.003; 95% CI, 0.96 to 7.05). Changes in centroids and mean absolute values for both corneal and refractive astigmatism also remained significant during the follow-up. Conclusion: ICRS combined with epi-off A-CXL represents an effective treatment for pediatric KC, providing sustained improvements in visual acuity, keratometry, and both refractive and corneal astigmatism over the follow-up period. These findings support its role as a comprehensive therapeutic approach to halt long-term disease progression and enhance visual function.