Identifying changes in topography key for cross-linking after PK, RK
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CHICAGO — Regular topography, preferably performed annually after keratorefractive or penetrating keratoplasty surgery, is ideal for detecting ectasia, according to a speaker.
“In general, we want to detect keratoconus and ectasia very early,” Kathryn M. Hatch, MD, said at Cornea Subspecialty Day at the American Academy of Ophthalmology meeting. “That includes our ectatic corneas, post-refractive, post-RK and post-PKP.”
Hatch shared pearls for cross-linking in patients who previously underwent penetrating keratoplasty, LASIK or radial keratotomy. After PK, it is important to look for changes in refraction and topography and ask about eye rubbing and sleep patterns. After LASIK, ophthalmologists should be mindful of flaps and incisions and treat the ocular surface, as these patients tend to have a high incidence of dry eye disease. After RK, it is important to watch for diurnal fluctuations, RK incisions and potential wound gape.
Collagen CXL is a procedure that is generally low risk with an uneventful recovery process, Hatch said. Patients should expect to wear visual aids after the procedure, and it is important to reassess the patient and conduct new fits for the aids 1 to 2 months after CXL. Complications can be vision threatening, are technique dependent and are usually related to removal of the epithelium.
“In the future, we hopefully will have more epi-on techniques, and we may be able to combine cross-linking with other procedures as well to achieve not just stabilization, but improvement of vision,” Hatch said.
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Hatch KM. Crosslinking in post-refractive ectasia and post-penetrating keratoplasty. Presented at: American Academy of Ophthalmology meeting; Sept. 30-Oct. 3, 2022; Chicago.
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