Outcomes of Conductive Keratoplasty Combined with Corneal Crosslinking in Advanced Ectatic Corneal Disease

Abstract

Purpose: To assess the effectiveness of a novel treatment for patients with advanced corneal ectasia and loss of visual acuity (VA). Conductive keratoplasty (CK) is performed to improve VA followed by epithelium-on (epi-on) corneal crosslinking (CXL) to stabilize the cornea after CK. Methods: Retrospective, exploratory cohort study. Patients with keratoconus or postsurgical ectasia and best spectacle-corrected distance VA (CDVA) ≤ 20/40 were included. Conductive keratoplasty was performed (ViewPoint CK System, Refractec, Inc., Bloomington, MN); followed a day later by epi-on CXL (CXLUSA/CXLO, Bethesda, MD/CXLO Encinitas, CA). Measures included uncorrected distance visual acuity (UDVA) and CDVA, as well as refractive and tomographic measures and tomographic indices. Results: Data from 50 eyes of 45 patients were analyzed. Mean follow-up was 15.1 ± 12.2 months (range: 2 to 51). Overall, UDVA and CDVA improved postoperatively. Subjective refraction and tomographic metrics did not show consistent changes, but changes in tomographic indices were associated with treatment follow-up time. At the 1-year visit, mean UDVA significantly improved over baseline (P = 0.009) by approximately 3 lines; mean CDVA improved significantly (P = 10 −5 ) by approximately 2 lines. No eye lost lines of CDVA. Change in the Index of Surface Variance (ISV) was associated with treatment, and the D-Index trended over follow-up time. Conclusion:Conductive keratoplasty with a proprietary epi-on CXL treatment improved vision in patients with advanced ectasia This CK/epi-on CXL treatment offers the possibility of improved VA for patients with compromised vision due to ectasia.

Preliminary Characterization of Predictive Factors of the Visual Change after Epi-On and Epi-Off Corneal Collagen Crosslinking Techniques

“…Besides these investigations, other CXL protocols have been evaluated that are based on the epi-on concept, such as the CXLO protocol that uses a new sodium iodide riboflavin formulation that theoretically allows a greater level of penetration [47][48][49][50][51]. ese investigations have shown that the use of the CXLO protocol can halt the progression of ectasia and result in better visual acuity without the risk associated to epi-off CXL [47][48][49][50][51].…”

“…These investigations have shown that the use of the CXLO protocol can halt the progression of ectasia and result in better visual acuity without the risk associated to epi-off CXL [ 47 – 51 ]. Three of these studies show the results of this type of CXL applied one day after conductive keratoplasty (CK) [ 47 – 49 ]. Sinjab et al [ 49 ] observed at the end of the follow-up a mean reduction of K max with the combination of CK and CXLO of 3.8 D with the mean baseline K max value of 65.1 ± 11 D. Rechichi et al [ 52 ] evaluated the changes in the refraction and corneal aberrations in keratoconus after the selective transepithelial topography-guided photorefractive keratectomy combined with accelerated corneal crosslinking (STARE-X) and demonstrated effective results to stop the progression of keratoconus.…”