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Fyodorov Lecture focuses on latest advances in keratoconus management
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ATHENS, Greece — Modern approaches to keratoconus management were the topic of this year’s Fyodorov Lecture, awarded at the European Society of Cataract and Refractive Surgeons winter meeting to José L. Güell, MD, PhD.
Two strategies, he said, have been validated by a long positive experience and studies: corneal cross-linking (CXL) and keratoplasty.
José L. Güell, MD, PhD, winner of the Fyodorov Lecture Award, with Pandelis A. Papadopoulos, MD, (left) and Spyros Georgaras, MD, vice president and president, respectively, of the Hellenic Society of Intraocular Implant and Refractive Surgery.
A combination with other strategies, such as PRK, Intacs (Addition Technology) and phakic IOLs — without forgetting the classic and still first-line option of contact lenses — aims at adjusting vision, which, particularly after cross-linking, remains poor.
“The central flattening produced by CXL is still unproven and does not uniformly occur in all patients. Visual improvement with CXL alone is not significant and is something you cannot predict,” Güell said.
There is increasing evidence showing that PRK is an effective option. Güell recommended a transepithelial approach because preoperative topographic data in these patients, who have an irregular epithelial distribution, would be altered when the epithelium is scraped.
Intracorneal rings produce some visual improvement in combination with cross-linking but should not be used to stabilize the cone.
Phakic IOLs are a helpful strategy, especially in patients with significant anisometropia who cannot benefit from contact lenses. The triple combination of cross-linking, intracorneal rings and phakic IOLs is showing interesting results, Güell said.
As far as keratoplasty is concerned, deep anterior lamellar keratoplasty is the best option, according to Güell. Of the several approaches currently used, his favorite is the visco-bubble technique, using viscoelastic instead of air. The benefits of combining DALK with cross-linking to improve stabilization have not yet been proven, he said. – by Michela Cimberle
Disclosure: Güell reports he is a consultant to Ophtec.