Refractive Surgical Correction Of Keratoconus

To discuss the risks and benefits of the different surgical procedure, including excimer laser photorefractive and phototherapeutic procedures plus corneal collagen cross-linking (CXL), intracorneal ring segments (ICRS) with and without CXL (as they don’t stop KC, but can improve the refractive condition in many cases), phakic intraocular lenses (pIOL) and refractive lens exchange with toric IOL implantation to correct the refractive error of patients with keratoconus

University of Bari; Vissum Miranza, Alicante; Postgraduate Ophthalmology school, Siena

An extensive literature search published in the MEDLINE/ PubMed and EMBASE database was performed to identify relevant articles (with no time restrictions) using the search terms: “refractive surgery,” “photorefractive keratectomy,” “phototherapeutic keratectomy,” “intracorneal ring segment,” “corneal cross linking,” “phakic intraocular lens,” “toric intraocular lens,” “intraocular lens” and “keratoconus.” Emphasis was given to RCTs, meta-analysis, original research, and prospective studies that focused on the different surgical options to manage the refractive error of keratoconic patients. Review articles were also included if they added new data.

ICRS implantation represents a minimally invasive surgical option with a high success rate and a low overall complication rate. allogenic ICRS consists of ring segments derived from allogenic eye bank-processed donor corneas. Selective topography-guided transepithelial PRK or PTK combined with CXL is another way in selected cases to improve BCVA.  The microphotoablative remodeling of the central corneal profile is planned by optimizing the optical zones and minimizing tissue consumption. two types of PIOL implant is considered in patients with stable disease and acceptable anatomical requirements. In patients with both cataracts and keratoconus, the correct IOL power is difficult to obtain due to the irregular corneal shape and K values.

Refractive surgery in QC today plays a refractive-therapeutic role with relevant scientific evidence to support it, representing a novel indication in a corneal disease that was previously considered a contraindication for it.