Notice the crab-claw appearance indicating pellucid marginal degeneration in the keratometric images (B). This grading scale is helpful when classifying a new keratoconus patient or monitoring an existing patient. TKC gives a grading from 0 (normal) to 4 (severe). Topographical keratoconus classification (TKC) value (in red, bottom of center column) = KC3 (A). Pentacam images showing pellucid marginal degeneration. We expect the likelihood of future corneal transplants to be greatly reduced for patients with keratoconus due to early intervention with CXL.įigure 2.
In our practice we have treated patients as young as 12 years and successfully halted the progression of keratoconus before it affected their vision. By halting the progression of keratoconus early, we give patients their best chance for maintaining the best visual potential. We recommend CXL to patients as early as possible in the progression of keratoconus (Figure 1). In 2016, the FDA approved the KXL System and Photrexa riboflavin formulations (Avedro acquired by Glaukos in 2019) for performing epithelium-off (epi-off) CXL procedures. 2 We’ve seen the benefits of CXL in strengthening the cornea, flattening keratometric values, and improving UCVA and BCVA. Twenty years ago, corneal collagen crosslinking (CXL) techniques were developed by researchers at the University of Dresden. Transplant options now include deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP). If the cornea becomes too thin or severely scarred, however, such as in the advanced stages of keratoconus, a corneal transplant may be the best treatment. Some mild stage keratoconus patients can be successfully managed by correcting distortions in vision with spectacles or specialty contact lenses. CXL can be a comanaged procedure if the comanaging doctors are comfortable with the arrangement.Epithelium-on CXL can be easier on patients, with faster recovery and less risk of infection.Only epithelium-off CXL is approved for use by the FDA.
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