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APRIL 2020 | EYEWORLD | 71
2. If there is significant epithelial remodeling
around the cone seen on epithelium mapping
as well as sufficient residual stroma, they
use PTK to reduce the cone, making sure to
remove no more than 50 µm.
3. If there is not significant epithelial remodel-
ing, they consider topography-guided PRK,
removing no more than 50 µm.
4. If there is significant coma across the pupil
and CDVA <20/40, they consider a single
intrastromal ring segment or asymmetric
segments.
C
rosslinking, while therapeutic to stop
progression of keratoconus and
corneal ectasia, leaves something to
be desired by patients in terms of
refractive outcomes. As such, cornea
specialists have been pairing it with
other devices and procedures, allow-
ing patients to get the best of both worlds: a
strengthened, stable cornea and improved visual
acuity.
Luke Rebenitsch, MD, shared his practice's
algorithm for adjunct treatments to crosslinking:
1. For patients with early ectasia and with CDVA
close to 20/20, they do crosslinking alone.
Crosslinking, combo procedures for
refractive outcomes in keratoconus
by Liz Hillman
Editorial Co-Director
Six-month difference maps showing crosslinking alone versus concurrent topography-guided (TG) PRK and
crosslinking. Both eyes improved 1 line in CDVA, while subjectively the patient noticed improvement only
in his left eye, which received concurrent treatment.
Source: Luke Rebenitsch, MD
Preoperative Postoperative Difference
Crosslinking
only
Crosslinking
and TG PRK
continued on page 72
