Optical pachymetry–guided custom excimer laser-assisted lamellar keratoplasty for the surgical treatment of keratoconus

Spadea, Leopoldo; Gizzi, Riccardo; Conocchia, Nicole Evangelista; Urbano, Sara

doi:10.1016/j.jcrs.2012.05.029

Cited by 12 publications

(9 citation statements)

References 24 publications

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“…Currently available treatments for keratoconus (rigid contact lens, lamellar keratoplasty, corneal rings) largely involve interventions which are done for tectonic, optical, or refractive reasons 19. Unfortunately, none of these options treat the underlying cause of ectasia, and therefore cannot stop the progression of keratoconus.…”

Section: Discussionmentioning

confidence: 99%

Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas

Spadea¹,

Mencucci²

2012

OPTH

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BackgroundThe purpose of this paper was to report the results of transepithelial corneal collagen cross-linking (CXL) with modified riboflavin and ultraviolet A irradiation in patients affected by keratoconus, each with thinnest pachymetry values of less than 400 μm (with epithelium) and not treatable using standard de-epithelialization techniques.MethodsSixteen patients affected by progressive keratoconus with thinnest pachymetry values ranging from 331 μm to 389 μm underwent transepithelial CXL in one eye using a riboflavin 0.1% solution in 15% Dextran T500 containing ethylenediamine tetra-acetic acid 0.01% and trometamol to enhance epithelial penetration. The patients underwent complete ophthalmological examination, including endothelial cell density measurements and computerized videokeratography, before CXL and at one day, one week, and one, 6, and 12 months thereafter.ResultsEpithelial healing was complete in all patients after one day of use of a soft bandage contact lens. No side effects or damage to the limbal region was observed during the follow-up period. All patients showed slightly improved uncorrected and spectacle-corrected visual acuity; keratometric astigmatism showed reductions (up to 5.3 D) and apical ectasia power decreased (Kmax values reduced up to 4.3 D). Endothelial cell density was unchanged.ConclusionApplication of transepithelial CXL using riboflavin with substances added to enhance epithelial permeability was safe, seemed to be moderately effective in keratoconic eyes with ultrathin corneas, and applications of the procedure could be extended to patients with advanced keratoconus.

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Section: Discussionmentioning

confidence: 99%

Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas

Spadea¹,

Mencucci²

2012

OPTH

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“…To circumvent these problems, some surgeons are now using an excimer laser to remove the recipient corneal stroma, leaving a good quality stromal bed surface 61. Therefore, customized excimer laser-assisted lamellar keratoplasty has been conceived as a valuable alternative to penetrating keratoplasty for the treatment of keratoconus and keratectasia 62. However, we recently reported a case of a patient with corneal ectasia which developed after excimer laser-assisted lamellar keratoplasty for keratoconus and a secondary photorefractive keratectomy for residual refractive error where the treatment of collagen corneal cross-linking with riboflavin and ultraviolet A (CXL) provided safe and effective management of the ectasia 63.…”

Section: Discussionmentioning

confidence: 99%

Corneal ectasia after myopic laser in situ keratomileusis: a long-term study

Spadea¹,

Cantera²,

Cortês³

et al. 2012

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BackgroundThe purpose of this study was to evaluate the long-term postoperative incidence of and key factors in the genesis of corneal ectasia after myopic laser-assisted in situ keratomileusis (LASIK) in a large number of cases.MethodsA retrospective review of one surgeon’s myopic LASIK database was performed. Patients were stratified into two groups based on date of surgery, ie, group 1 (1313 eyes) from 1999 to 2001 and group 2 (2714 eyes) from 2001 to 2003. Visual acuity, refraction, pachymetry, and corneal topography data were available for each patient from examinations performed both before and after the refractive procedures.ResultsOf the 4027 surgically treated eyes, 23 (0.57%) developed keratectasia during the follow-up period, which was a minimum seven years; nine eyes (0.69%) were from group 1 and 14 eyes (0.51%) were from group 2. The onset of corneal ectasia was at 2.57 ± 1.04 (range 1–4) years and 2.64 ± 1.29 (range 0.5–5) years, respectively, for groups 1 and 2. The most important preoperative risk factors using the Randleman Ectasia Risk Score System were manifest refractive spherical error in group 1 and a thin residual stromal bed in group 2. Each of the cases that developed corneal ectasia had risk factors that were identified.ConclusionEctasia was an uncommon outcome after an otherwise uncomplicated laser in situ keratomileusis procedure. The variables present in eyes developing postoperative LASIK ectasia can be better understood using the Randleman Ectasia Risk Score System.

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“…The study was conducted according to the principles of the Declaration of Helsinki and good clinical practice. All the patients had had ELLK at least 24 months earlier using a previously described technique,12 with suture removal at least 6 months before PRK. They had stable refraction for at least 6 months and were intolerant of contact lenses.…”

Section: Methodsmentioning

confidence: 99%

Simultaneous topography-guided PRK followed by corneal collagen cross-linking after lamellar keratoplasty for keratoconus

Spadea¹,

Paroli²

2012

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BackgroundThe purpose of this paper is to report the results of using combined treatment of customized excimer laser-assisted photorefractive keratectomy (PRK) and prophylactic corneal collagen crosslinking (CXL) for residual refractive error in a group of patients who had previously undergone lamellar keratoplasty for keratoconus.MethodsThe study included 14 eyes from 14 patients who had originally been treated for keratoconus in one eye by excimer laser-assisted lamellar keratoplasty (ELLK), and subsequently presented with residual ametropia (−6.11 D ± 2.48, range −2.50 to −9.50). After a mean 40.1 ± 12.4 months since ELLK they underwent combined simultaneous corneal regularization treatment with topographically guided transepithelial excimer laser PRK (central corneal regularization) and corneal CXL induced by riboflavin-ultraviolet A.ResultsAfter a mean 15 ± 6.5 (range 6–24) months, all eyes gained at least one Snellen line of uncorrected distance visual acuity (range 1–10). No patient lost lines of corrected distance visual acuity, and four patients gained three lines of corrected distance visual acuity. Mean manifest refractive spherical equivalent was −0.79 ± 2.09 (range +1 to −3.0) D, and topographic keratometric astigmatism was 5.02 ± 2.93 (range 0.8–8.9) D. All the corneas remained clear (haze < 1).ConclusionThe combination of customized PRK and corneal CXL provided safe and effective results in the management of corneal regularization for refractive purposes after ELLK for keratoconus.

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Optical pachymetry–guided custom excimer laser-assisted lamellar keratoplasty for the surgical treatment of keratoconus

Abstract: Two-year findings indicate that pachymetry-guided custom excimer laser-assisted lamellar keratoplasty is a useful surgical treatment for moderate to advanced keratoconus, preventing the need for the more invasive procedure of penetrating keratoplasty.

Cited by 12 publications

References 24 publications

Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas

Transepithelial corneal collagen cross-linking in ultrathin keratoconic corneas

Corneal ectasia after myopic laser in situ keratomileusis: a long-term study

Simultaneous topography-guided PRK followed by corneal collagen cross-linking after lamellar keratoplasty for keratoconus

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