简介：·AIM:Toevaluateandcomparetheefficacyandstabilityofintrastromalcornealringsegment(ICRs)implantationwithcross-linking(CXL)usingdifferentsequenceandtiming.·METHODS:Inthissingleretrospectivestudy,86keratoconiceyessubjectedtheICRsimplantation.Weanalyzedonly41eyesthathadcompletefollow-ups.Theyweredividedintothreegroups:ICRsimplantationwasappliedonly(groupnormal),ICRsfirstfollowedbyCXLimmediately(groupCXL-S),CXLfirstfollowedbyICRslongafter(groupCXL-B).Thevisualacuity,refractiveresults,keratometrywerecomparedpreoperativelyand1ypostoperatively.Theirdifferencesamongthethreegroupswerealsoanalyzed.·RESULTS:Groupnormalcomprised25eyes,groupCXL-S8eyes,andgroupCXL-B8eyes.Therewereimprovementsinthemeanuncorrecteddistancevisualacuity(UDVA)andthemeancorrecteddistancevisualacuity(CDVA)comparedpreoperativelyand1ypostoperatively[UDVA:0.31(P=0.030)logarithmicminimumangleofresolution(logMAR)groupnormal,0.4(P=0.020)groupCXL-S,0.45(P=0.001)groupCXL-B;CDVA:0.21logMAR(P=0.013)groupnormal,0.30(P=0.036)groupCXL-S;0.26(P=0.000)groupCXL-B].Therefractiveandtopographicoutcomesalsoshowedimprovements.Intermsofcomparisonsamongthethreegroups,allthePvalueswereabove0.05,showingnosignificantdifference.ButonlygroupCXL-BhadimprovementinUDVAandCDVAforallthepatients.·CONCLUSION:Withsafetyandgoodvisualoutcomes,ICRsimplantationisaviablealternativeforkeratoconus.Nosignificantdifferencewasfoundamongthesethreegroups.