Eyeworld

EW INTERNATIONAL 66 November 2018 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer study. The flattening rate was 37.7%, according to the study's outcomes. The authors think that a restric- tion to corneas with a maximum K reading of greater than 54 D could have resulted in a significant flatten- ing rate of 51%. None of the other preoperative parameters that were considered such as age, sex, diagno- sis, CDVA, and corneal shape factors had a significant impact on corneal flattening. 2 Looking at the effects of CXL in four different corneal thickness The literature supports the combination of ICRS and CXL for the treatment of keratoconus M ounting evidence suggests that corneal crosslinking (CXL) can safely be combined with intracorneal ring segments (ICRS) in keratoconus pa- tients and in individuals with post- LASIK ectasia. In a symposium on "Choosing the right surgical option" at the 2018 World Ophthalmology Congress, Rafael Barraquer, MD, PhD, Barraquer Institute, Barcelo- na, Spain, discussed the advantages of coupling these two procedures, explaining that the combination of CXL and ICRS could have two possible advantages: enhancing the refractive/topographic effects of the surgeries and increasing corneal stability. Dr. Barraquer highlighted relevant studies from the literature to illustrate the individual and combined efficacy of these two procedures. Making the case for CXL Progressive keratoconus can be stabi- lized long term using CXL, accord- ing to evidence gathered from 480 eyes of 272 patients in a retrospec- tive study that had a minimum fol- low up of 6 months and a maximum follow up of 6 years. The corneal steepening decreased significantly by 2.68 D in the first year, 2.21 D in the second year, and 4.84 D in the third year. The BCVA improved significantly by >1 line/remained stable in 53%/20% of 142 eyes in the first year, 57%/24% of 66 eyes in the second year, and 58%/29% of 33 eyes in the third year. 1 A preoperative K reading over 54 D is associated with statistically significant corneal flattening within the first year after CXL, as was demonstrated in more than 50% of the 151 cases with progressive primary keratectasia treated with standard CXL, in another unrelated groups, thinnest corneal thick- ness (TCT) <400 µm, 400–450 µm, 450–500 µm, and TCT >500 µm, of 101 patients (123 eyes) with progres- sive keratoconus in a retrospective study showed that CXL was success- ful in halting ectatic progression and found a negative linear correlation between the TCT and K-max. Ad- vanced cases of progressive keratoco- nus seemed to obtain a greater bene- fit than less advanced cases from the flattening effects of CXL. 3 Making the case for combining If CXL slows keratoconus progres- sion and stabilizes the cornea and ICRS implantation reshapes it, a combination of the two procedures would seem advantageous. Dr. Bar- raquer discussed some of the studies that investigated the combined approach. "What is the best way to perform these surgeries? Results of one study show that same day ICRS with CXL surgery is safe and effec- tive but may be the cause of delayed healing and delayed visual acuity Combined treatments that enhance outcomes: CXL and intracorneal rings 20-year-old patient with moderate keratoconus and +2 –5 x 100 degrees (but up to 16 D of topographic astigmatism). Initial implantation of two ICRS following nomogram (left) resulted in marked overcorrection (–2 –7 x 160 degrees). The upper ICRS was then explanted with a good result (–2 x 135 degrees and 20/25+ UCVA) (right). Presentation spotlight

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