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Limited PRK feasible in keratoconus patients following UVA corneal cross-linking

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LONDON — Cross-linking of corneal collagen using ultraviolet-A radiation, followed by topography-guided PRK, can effectively improve vision in patients with keratoconus and post-LASIK ectasia, according to a surgeon speaking here.

"Collagen cross-linking is a rapidly growing practice in refractive surgery. It needs caution, but results are rewarding," John Kanellopoulos, MD, said in a presentation at the European Society of Cataract and Refractive Surgeons annual meeting. "We now have the experience of a considerable number of cases of both keratoconus and corneal ectasia that were effectively treated with this modality."

At 16 months' follow-up, corneal ectasia had stabilized in all cases, and corneal flattening was obtained in proportion to cone size, for an average of 3 D. Some eyes also obtained a reduction in spherical equivalent, and the procedure caused no changes in endothelial cells, Dr. Kanellopoulos said.

In 27 eyes with keratoconus, the ultraviolet-A (UVA) collagen cross-linking treatment was followed by limited topography-guided ablations to enhance visual rehabilitation. Several eyes with post-LASIK ectasia were similarly treated. For both conditions, patients experienced a considerable improvement in vision, he said.

"In one patient with post-LASIK ectasia and Intacs segment implants (Addition Technology), [uncorrected visual acuity] was 20/400. We removed the Intacs and performed the UVA treatment, obtaining a visual acuity of 20/80. Following topography-guided treatment, 12 months postop, the patient had achieved 20/20," Dr. Kanellopoulos said.

This case series shows that UVA corneal cross-linking can be used as a pre-treatment to enable ectatic corneas to undergo a limited 50-µm treatment with topography guided PRK, which would be otherwise contraindicated, he noted.

"Our therapeutic goal was not emmetropia, but improved best spectacle corrected visual acuity. Some of these patients now wear soft contact lenses or glasses," Dr. Kanellopoulos said.

This technique may be seen as a means for preventing the need for penetrating keratoplasty, he added.