Purpose: To describe the visual and topographical changes after accelerated corneal collagen cross-linking (ACXL) in keratoconus-affected eyes. Methods: Clinical records of patients with keratoconus-affected eyes that underwent ACXL treatment and had 24 months of follow-up were reviewed. Data regarding demographics, visual acuity (VA), refraction and Sheimpflug values before and post ACXL were analyzed. We included patients with keratoconus older than 12 years old, with corneal thickness greater than 400 microns and steepest keratometry <60 diopters by Sheimpflug (Pentacam), with reported uncorrected distant visual acuity (UDVA), manifest refraction and best-corrected visual acuity (BCVA) evaluation pre ACXL and 24 months after surgery. The exclusion criteria were: history of ocular trauma, anterior segment surgery, retinal detachment or any type of maculopathy. Results: 21 eyes were included. Mean age was 27 years. Mean uncorrected distant VA (UDVA) before the procedure was 1.01 logMAR (20/200 Snellen) and after 24 months improved significantly to 0.62 logMAR (20/83 Snellen) with a p value of 0.005. No statistical significant difference was found between preoperative and postoperative refractive, keratometric and pachymetric data. Induced astigmatism value was -1.11 D (range 0.13 D – 2.28 D). Conclusions: ACXL is a technique to prevent the progression of keratoconus, however refractive and VA changes could be expected after procedure. The observed changes must be considered when performing the procedure together with refractive surgery.

Purpose: To evaluate visual and refractive outcomes after intracorneal circular ring implantation with femtosecond laser for keratoconus treatment. Design: Prospective, cohort Methods: Were included 22 eyes of 16 adults patients with central keratoconus who had been implanted with continuous intracorneal circular ring (ICCR) MyoRing (Dioptex GmbH, Linz, Austria) in a pocket created by femtosecond laser (Ziemer Z6 LDV, Port, Switzerland). Visual and refractive outcomes, keratometry, pachymetry and asphericity were evaluated at one, three, six month and one year postoperative. Results: Uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) improved from 1,33 (Standard deviation [SD]: 0,37) to 0,38 logMAR (SD 0,16) (p<.001) and from 0,25 (SD: 0,15) to 0,21 logMAR (SD: 0,23) (p=0,43) respectively at one year postoperative. Central keratometry, sphere, cylinder and corneal asphericity presented reduction of 8,13 Diopters (D) (p<.001), 5,42D (p<.001), 2,03D (p=0.01), 1,46 e2 (p=0,00) respectively. Visual, refractive and keratometric results did not reveal significant changes after the third month of follow up. Conclusion: Intracorneal circular ring implantation using femtosecond laser is an effective and safe procedure for central keratoconus treatment. Keratometric and refractive values can be effectively improved and good visual outcomes achieved. RESUMEN Objetivo: Evaluar los resultados visuales y refractivos tras el implante de anillo intracorneal circular continuo, usando láser de femtosegundo en el tratamiento de pacientes adultos con queratocono. Diseño: Prospectivo de cohorte. Materiales y Métodos: Se incluyeron 22 ojos de 16 pacientes, con diagnóstico de queratocono tipo central a los cuales se les implanto un anillo intracorneal circular continuo (ICCR), MyoRing (Dioptex GmbH, Linz, Austria) en un bolsillo creado con láser de femtosegundo (Ziemer Z6 LDV, Port, Switzerland). Se evaluó resultado visual, refractivo, queratometrías, paquimetría y asfericidad corneal al mes , tres meses, seis meses y a un año posoperatorio. Resultados: La agudeza visual sin corrección (AVSC) y la agudeza visual con corrección (AVCC) mejoraron de 1,33 (Desviación estándar [DE]: 0,37) a 0,38 logMAR ([DE]:0,16, p=0.001) y de 0,25 ([DE]:0,15) a 0,21 logMAR ([DE]:0,23, p= 0,43) respectivamente al año postoperatorio. La queratometría central, la esfera, el cilindro y la asfericidad corneal presentaron disminución de 8,13 Dioptrías (D) (p <.001), 5,42 D (p<.001), 2,03D (p=0.01) y 1,46 e2 (p<0,000) respectivamente. Los resultados visuales, refractivos y queratométricos no presentaron cambios significativos a partir del tercer mes posoperatorio. Conclusiones: El implante del anillo intracorneal circular continuo con láser femtosegundo, demostró ser un procedimiento eficiente y seguro para el tratamiento de queratocono tipo central, mejorando significativamente los valores queratométricos y refractivos, logrando buenos resultados visuales.