Bilateral Elza-Pace For Early Keratoconus In A Young Patient: A Case Report

To present a case of a young patient with bilateral early-stage keratoconus who underwent ELZA-PACE (Phototherapeutic Keratectomy-Assisted Customized Epi-On Cross-Linking), achieving excellent visual and topographic outcomes, allowing him to resume the use of soft contact lenses.

ELZA Institute, Zurich, Switzerland.

A 21-year-old Moroccan patient with progressive keratoconus and poor vision with soft contact lenses presented for treatment.

Diagnosed with early-stage keratoconus (OD: A1B2C2D1, OS: A1B1C1D1) and no prior ocular surgery, he underwent same-day bilateral ELZA-PACE to reduce logistical constraints.

PTK was used for epithelial removal over the cone, followed by differential fluence CXL (higher fluence epi-off, lower epi-on).

Recovery was uneventful, with BCVA improving from OD: 0.5, OS: 0.63 pre-op to 1.0 in both eyes at 3 months.

He resumed soft contact lens wear comfortably and was highly satisfied.

This case demonstrates ELZA-PACE as a customized, tissue-preserving approach for early keratoconus, achieving corneal regularization and improved vision. Bilateral same-day treatment is a viable option for international patients. Topographic-guided PTK-assisted CXL shows promise for stabilizing and optimizing corneal shape.