Live-epikeratophakia is a safe and minimally invasive extraocular procedure suitable for keratoconus stage I-II. Progression of keratoconus may be arrested. If unsuccessful, the procedure is complementable and there is no interference with a later penetrating keratoplasty.
Circular keratotomy provides significant reduction in astigmatism, improved BSCVA, and stabilization of astigmatic changes in most eyes, although some eyes show limited benefit. Eyes with higher preoperative astigmatism appear to be more likely to benefit from the procedure than those with lower preoperative astigmatism. Circular keratotomy also resulted in reasonable clinical results for the treatment of stage I and II keratoconus.
In patients with keratoconus stage I to III, L-EPI or DLKP appeared to be very useful therapies. Both procedures seem to end progression of the disease and allow to preserve the healthy recipient endothelium. If unsuccessful, either procedure may be repeated. Neither procedure precludes possibly later needed PKP.
The intracorneal ring prevented the donor button from distortions related to peripheral changes or suture traction. A sutured intracorneal ring appears to be a safe and effective aid in keratoplasties. Further evaluation in a multicenter study with larger patient numbers and indication-specific longer follow-ups is under way.
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