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 (K m ) with the flattest (K 1 ) and steepest (K 2 ) 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. K m decreased by 2.74 D at 60 months ( P = 0.022; 95% CI, 0.24 to 5.24), whereas K 2 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.