Dual-Goal Therapy For Keratoconus: Staged Cxl And Ticl For Stability And Correction

To evaluate the efficacy and safety of a sequential treatment combining Corneal Cross-Linking (CXL) with Toric Implantable Collamer Lens (TICL) implantation in patients with keratoconus. This study aims to validate the role of this combined therapy in improving visual acuity and arresting disease progression.

Keratoconus, a non-inflammatory ectatic disorder, involves corneal thinning and protrusion that causes progressive irregular astigmatism and severe vision loss, potentially leading to blindness. As conventional correction is often inadequate and laser surgery is contraindicated due to high risk, a safe and effective refractive surgical alternative is urgently needed for these patients.

This is a case report of a 22-year-old male with a 14-year history of progressive visual decline and a history of eye rubbing, who was diagnosed with keratoconus 5 years prior. A two-step “stabilize first, correct later” strategy was adopted. Initially, CXL was performed on the more severely affected right eye. One month postoperatively, following corneal stabilization, customized TICLs were implanted bilaterally to correct his high myopia and astigmatism.

At the 1-day postoperative visit, the patient’s uncorrected visual acuity (UCVA) improved significantly from 0.1 preoperatively to 1.0-1.2 bilaterally. Intraocular pressure (IOP) was normal, and the TICLs were well-centered with a safe vault. Short-term follow-up showed significant improvement in vision, enhanced corneal stability, and halted progression of the keratoconus. Mild dry eye symptoms experienced in the early postoperative period resolved with symptomatic treatment.

This case demonstrates that for indicated patients, the two-step strategy of sequential CXL and TICL implantation yields excellent outcomes. This approach not only halts disease progression but also restores visual function, representing a safe, effective, and predictable procedure. It provides valuable experience and robust evidence for managing complex keratoconus cases. Future refinements in cross-linking technology are expected to further broaden the application of this combined strategy, offering a more comprehensive treatment solution for patients with keratoconus.