Visual and Tomographic Outcomes of a 300° Arc-length ICRS Implantation in Moderate to Advanced Central Keratoconus

To evaluate the safety and efficacy of corneal collagen crosslinking (CXL) for the treatment of progressive keratoconus.

Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.

To determine clinical and demographic risk factors for corneal transplantation in keratoconus patients. Case control study. Tertiary referral center. All keratoconic eyes presenting to the Duke University Eye Center from January 1, 1997, to December 31, 2002. OBSERVATION PROCEDURE AND OUTCOME MEASURES: Cases were defined as eyes undergoing transplantation during the study period for keratoconus. Controls were defined as eyes that did not undergo transplantation. Cases were compared with controls to determine clinical and demographic risk factors for corneal transplantation. A total of 131 eyes with keratoconus were studied; 59 cases were compared with 72 controls. Groups were similar with respect to sex and race. Significant univariate risk factors for corneal transplantation were best-corrected vision worse than 20/40 (OR 3.2, 95% CI 1.1 to 9.8), cylinder >10.0 diopters (OR 3.5, 95% CI 1.0 to 12.4), and average keratometry >55 diopters (OR 5.6, 95% CI 1.4 to 21.9). In multivariate analysis, age 30 or younger conferred a sevenfold increased risk of transplantation compared with ages of more than 40 (OR 7.7 for ages 21 to 30 and OR 25.8 for ages < or = 20). Multivariate analysis also showed duration of disease 5 years or less and steep average keratometry as significant risk factors. A subset of young keratoconic patients with high keratometry values may represent an underrecognized risk group for corneal transplantation. Best-corrected visual acuity worse than 20/40 at presentation and astigmatism are other clinical indicators of increased risk of corneal transplantation in keratoconus patients.