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Clinicians assisted by array of techniques to manage corneal ectasia
Keen awareness, strict screening criteria and increased use of penetrating keratoplasty have reduced the incidence of corneal ectasia, according to a physician, and options for managing the condition continue to expand.
 David R. Hardten |
"Ectasia, as we become more careful about our selection for patients having corneal refractive surgery, is less common because of the increased awareness and tighter criteria for screening, as well as increased use of PRK and femtosecond laser," David R. Hardten, MD, said in a presentation at OSN New York 2009.
Some patients with borderline ectasia do well with LASIK, and some do poorly and develop progressive ectasia leading to vision loss.
"Our need for ectasia management around the time of refractive surgery, as well as in naturally occurring keratoconus or pellucid patients, we need to have those options before us," Dr. Hardten said. "Our options continue to expand."
Management options include glasses, contact lenses, collagen cross-linking, Intacs implants (Addition Technology) with conductive keratoplasty, lamellar corneal transplantation and PK, Dr. Hardten said.
Cross-linking, widely used outside the U.S., involves the absorption of riboflavin into the corneal stroma with the aid of ultraviolet light to stiffen the cornea.
"It's fairly simple and straightforward as long as you take off the endothelium and make sure that you saturate the corneal stroma and make sure that the light source is appropriately focused on the cornea with the appropriate energy," Dr. Hardten said.
U.S. clinical trials for cross-linking have shown positive results, he said.
Intacs implants with CK stabilize ectasia in some patients, but other patients need lamellar keratoplasty or PK, Dr. Hardten said.
Above all, ectasia is not completely preventable.
"How do we prevent ectasia?" Dr. Hardten said. "I think it's impossible to totally prevent ectasia, but we should be looking for those patients at higher risk: unstable refractive error, unusual topography, posterior elevation abnormalities. Asymmetry between the eyes, that's a real high risk factor."
Ectasia continues to be the most feared complication of keratorefractive surgery, but advances in treatment have and will greatly reduce the impact of this still rare problem. Deep anterior lamellar keratoplasty (DALK) offers the benefit of maintaining a patient’s own endothelium in a near-full-thickness procedure. Collagen cross-linking, while still a “young” procedure, allows us to halt and sometimes reverse progression in a minimally invasive way.
– John A. Hovanesian, MD, FACS
OSN
Cornea/External Disease Board Member
OSN New York 2010 will be held November 19-21, 2010 at the Sheraton New York Hotel & Towers in New York City. Learn more at OSNNY.com.