Association of Ferrara Intracorneal Ring Segments with Phakic Intraocular Lens for Improved Visual Acuity in Young Keratoconus Patients: A Case Series

Ab s t r Ac t Aim: We present a case series involving five eyes in four young patients with advanced keratoconus who were implanted with Ferrara intrastromal corneal ring segments (ICRS) followed by phakic intraocular lens (PIOLs). Background: ICRS have been used for the management of keratoconus in order to prevent further keratoconus progression and improve visual performance. Nonetheless, many patients may still suffer from moderate to high myopia after ICRS, requiring refractive error correction, which may not be achieved with glasses, contact lenses, or laser refractive surgery. For such cases, PIOLs have emerged as an alternative to correct residual refractive errors. Case description: Patients were aged between 13 years and 32 years at ICRS implantation. Around 6 months after ICRS implantation, patients were submitted to a second procedure for the implantation of an implantable collamer lens (ICL), Artisan or Artiflex PIOL to correct residual myopia. After the combined Ferrara ICRS and PIOL implantation, all treated eyes demonstrated a significant improvement in topographic findings and visual acuity, with reduced refraction and keratometric astigmatism. Conclusion: The combined procedure was successful in reshaping the cornea and improving visual acuity of patients. Clinical significance: The association of ICRS and PIOL can be an important alternative that should be considered to provide young patients with improved visual acuity in a moment of their lives when they are at their most productive.