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Progression of keratoconus after DALK: surgical option for the peripheral cornea of the host

Poster Details

First Author: J.Grandin ARGENTINA

Co Author(s):    C. Gordillo   A. Lotfi                 

Abstract Details


To describe the efficacy and safety of the combined technique of intracorneal ring segment implantation (ICRs) assisted with femtosecond laser in association with a simultaneous flash cross linking (CXL) in the peripheral cornea for the reduction of high astigmatism in patients that underwent previous deep anterior lamellar keratoplasty (DALK) and present high astigmatism and topographic instability due to peripheral progression.


All surgeries were performed at Cornea Department Zaldivar Institute- Mendoza, Argentina.


This retrospective observational study included patients with previous keratoconus (KC) that were treated with DALK and after at least 12 months of the surgery had a high residual astigmatism in association with corneal instability. Inclusion criteria were absence of corneal scars, high regular astigmatism (> -5 D), corneal instability attributable to presence of thinning due to KC progression. Complete ophthalmologic examinations, uncorrected visual acuity (UCVA), best corrected visual acuity (CDVA), keratometric values and corneal thickness were performed Data were measured preoperatively, and at 12, 24 and 36 months after the surgery.


38 eyes of patients with KC were implanted with ICRs assisted with femtosecond laser in association with CXL performed in peripherial receptor corneal ring area. The mean age of the patients was 42.75 ± 15.49 years, the mean time between corneal graft surgery and ICR implantation was 36 months. Mean UCVA (logMAR) changed from 1.18 ± 0.45 preoperatively to 0.15 ± 0.14 postoperative (p <0.001), and CDVA from 0.38 ± 0.19 to 1.2 ± 2.44 ( P <0.0001). Kmax decreased from 51.1 D preoperatively to 47.7 D (p <0.0003) postoperatively.


Progression of KC due to peripheral corneal instability in association with high astigmatism can be treated using the combined technique ICRs implantation and flash peripherical Cross linking as this shows to be a safe and reproducible technique presenting surface regularization and stability in final refraction, avoiding keratometric changes due to a progression of keratoconus.

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