Keratoplasty plus cross-linking may be efficacious in progressive keratoconus
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FRANKFURT, Germany — Intrastromal lamellar keratoplasty combined with collagen cross-linking enhances the tectonic stability and biomechanical strength of keratoconic corneas while flattening the cornea and improving visual acuity.
“We can use this as an alternative procedure to stabilize progressive keratoconus in thinner corneas in which we cannot perform just collagen cross-linking,” M.S. Swathi, MD, said at the ESCRS winter meeting.
The procedure entails the femtosecond laser-assisted creation of a stromal pocket at 180 µm depth and the insertion in the pocket of a donor lenticule 150 µm thick and 8 mm to 8.75 mm in diameter. CXL is then performed after removal of the epithelium.
“Our objective was to evaluate the corneal biomechanical changes following the procedure. We conducted a study on 10 patients with progressive keratoconus, following them up for a period of 6 months. We mainly included patients who had a minimum thinnest pachymetry of 350 µm to 400 µm, with best corrected visual acuity lower than 6/18 who were intolerant to contact lenses,” Swathi said.
Corneal thickness increased from 428 µm to 557 µm, and Corvis ST (Oculus) parameters, including stiffness and deformation amplitude, significantly improved. Topography also showed significant changes, with flattening of 1.06 D in K1, 2.42 D in K2 and 3.84 D in maximum keratometry. Uncorrected visual acuity and BCVA improved by about one line.
“If you look at the postop clinical photographs, you can see the lenticule has beautifully cleared up at the 6-month period and has maintained stability right from 1 month postop,” Swathi said.
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Swathi MS, et al. Corneal biomechanical changes following keratoplasty plus (intrastromal lamellar keratoplasty combined with collagen cross-linking) procedure in progressive keratoconus – pilot study. Presented at: ESCRS winter meeting; Febr. 15-18, 2024; Frankfurt, Germany.
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