It is time for a Turning Point in Keratoconus

Abstract

It is time for a Turning Point in KeratoconusKeratoconus (KC) is no longer a rare disease 1 , especially in certain geographical areas it reaches peaks of endemic value. The therapies and innovations of the last years', starting with crosslinking, have drastically changed the prognosis and quality of life of our patients.New combined therapies, minimally invasive refractive enhancement treatments, have changed and are changing history. 2 Increasingly sophisticated diagnoses, intelligent CT scanners, machine learning and artificial intelligence are at the service of ophthalmologists who are passionate about the subject and of patients for higher, refined and early diagnoses. 3 This has made keratoconus a subspecialty of modern ophthalmology and poses ever new and exciting challenges in the clinical, diagnostic, and therapeutic fields. There was a need for an international society dedicated to this disease, distinct and separate, but which is open to dialogue with the most important international societies of refractive and anterior segment eye surgery.Thus, the IKS (International Keratoconus Society) was finally born, the home of ophthalmologists who deal with keratoconus and of all those who want to dedicate themselves to this fascinating sector of ophthalmology.Such an important Society could not fail to have an equally important scientific Journal, and we have the honor of having the International Journal of Keratoconus and Ectatic Corneal Diseases (IJKECD) as our official IKS scientific Journal. 3 I cannot hide a certain emotion, because it was precisely in this Journal that the M nomogram 4,5 for the standardized treatment of individualized crosslinking of ectatic corneas of all thicknesses was born, as awarded in the ESCRS Congress in 2019 in Paris with the "Joseph Colin Prize" for innovating therapies in the field of Keratoconus. 4,5 The "M nomogram" allows safe and effective setting of CXL parameters based on thickness minimum preoperative corneal membrane, also allowing the standardized treatment of thin and ultrathin ectatic corneas with a minimum thickness between 250 and 400 µm, keeping the fluence standardized in the Dresden Protocol constant (5.4 J/cm 2 ). 4,5 Actually, the preliminary results on new epithelium-on accelerated CXL protocols with progressively higher fluence and pulsed light show that a new pachymetry-based PFPL M Epi-on ACXL nomogram stabilizes ectasia progression. 6 Higher fluence Epi-on ACXL increases CXL penetration, with better functional outcomes in the absence of complications, thus paving the way to a replacement of epithelium-off crosslinking treatments. From a clinical and practical perspective, a safer and faster transepithelial crosslinking treatment with an efficacy profile comparable to Epi-off CXL, with no adverse events and capable of quickly rehabilitating patients with progressive KC to resume their school or work activities, represents a great challenge and a highly interesting goal. The early evidence of my recent studies will allow surgeons to extend the indication...