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First Author: J.Grandin ARGENTINA
Co Author(s): A. Lotfi
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To discuss the indications of use of intracorneal ring segments (ICRs), corneal crosslinking (CxL), and intraocular contact lenses (ICL) for keratoconus treatment depending on the stage and type of keratoconus and to define a treatment algorithm for keratoconus
Zaldivar Institute, Mendoza, Argentina
Two case studies of patients with keratoconus.
A 25-year-old male patient presented with stage III keratoconus in the right eye. He had an uncorrected distance visual acuity (UDVA) of counting finger, a corrected distance visual acuity (CDVA) of 20/100, and refraction of -4.75 Sph -4.00 Cyl Ṫ 30Ḟ. One year after ICR implantation followed by CxL, the patients CDVA improved to 20/40, but he still had high residual refraction (-4.75 Sph -1.00 Cyl Ṫ 150Ḟ). Therefore, a toric ICL was implanted. Six months post-ICL implantation, refraction improved to +0.75 Sph -0.50 Cyl Ṫ 75Ḟ. UDVA and CDVA were 20/30 and 20/25 respectively. The second case was a 32-year-old male with keratoconus in the left eye, UDVA 20/150, CDVA 20/60, and refraction -8.50 Sph -6.00 Cyl Ṫ 50Ḟ. One year after ICR implantation followed by CxL, UDVA improved to 20/80, CDVA was 20/40, and refraction was -5.00 Sph -1.50 Cyl Ṫ 135Ḟ. A toric ICL was implanted to improve residual refraction. Six months post-ICL implantation, UDVA improved to 20/30, CDVA improved to 20/25, and refraction improved to +0.75 Sph -0.50 Cyl Ṫ 75Ḟ.
ICRs and CxL are both excellent options for patients with early stage keratoconus. In cases with high refractive error, combination therapy of ICRs and CxL followed by ICL or toric-ICL implantation has been found to be most effective in our hands. ICLs are an excellent option for treating residual refractive errors in keratoconic patients; however, prior to ICL implantation, ectasia progression must be halted and the corneal surface must be regularized