Technique of simultaneous femtosecond laser assisted Myoring implantation and accelerated intrastromal collagen cross-linking for management of progressive keratoconus: A novel technique

• Simultaneous intrastromal pocket riboflavin instillation for CXL and ICR implantation is an effective modality for management of keratoconus.
• Early postoperative corneal haze may be seen with previous similar method that limits visual recovery. Postoperative corneal haze may be avoided by applying Dextran Free Riboflavin and epi-on CXL.
• Distribution of riboflavin is accelerated by intrastromal instillation.
• This technique has both advantages of epi-on (no pain,no epithelial debridement, decreased risk of haze and infection) and epi-off CXL (good distribution of riboflavin and effective cross-linking) while lacks their drawbacks.
• Applying combined femto-assisted Myoring implantation and accelerated corneal intrastromal collagen cross linking with Dextran Free Riboflavin is a safe and effective technique for management of progressive keratoconus.

PurposeTo describe a novel surgical technique for the management of progressive keratoconus by simultaneous femtosecond laser-assisted Myoring implantation and accelerated corneal intrastromal collagen cross-linking with Dextran Free Riboflavin.MethodsAfter creating a corneal pocket with femtosecond laser, Dextran Free Riboflavin was injected into the intrastromal pocket. Then the Myoring was implanted in the corneal pocket and accelerated corneal intrastromal collagen cross-linking was performed with no epithelial debridement.ResultsThe cornea remained clear and the central keratometry was decreased significantly with marked improvement in uncorrected visual acuity up to two years following treatment. Anterior segment OCT revealed good centration and intended implant depth with desirable increase in the corneal stromal reflectivity confirming effective collagen cross-linking.ConclusionSimultaneous femtosecond laser-assisted Myoring implantation and accelerated corneal intrastromal collagen cross-linking with Dextran Free Riboflavin is a safe and effective technique for management of keratoconus and improving vision.