Posters

Combination of CXL and ReLEx SMILE for treatment of mild and high myopia on corneas with forme fruste keratoconus: case report 20 months follow up

Poster Details

First Author: T.Juhas SLOVAKIA

Co Author(s): T. Juhas   A. Aliyakparova                 

Abstract Details

Purpose:

Corneas with significant risk of ectasia are contraindicated for standard refractive laser surgery. Many case are not distinct and surgeon has to decide whether to take risk or not. Should refractive lens extraction under the crosslinked anterior stroma crust reduce risks, provide desired result with stable cornea, predictable refraction and be a way how to treat such corneas? We present a case of young female with bilateral CXL/Relex Smile treatment of mild and high myopia on suspicious corneas with 20months follow up.

Setting:

Oftum laser eye surgery clinic, Astana, Kazakhstan, Tomas Juhas jr. MD, PhD., Tomas Juhas sr., MD, PhD., Aizhan Aliyakparova MD.

Methods:

19 years old female was contraindicated to refractive laser surgery due to subclinical keratokonus. At 6months follow up progression of keratokonus on left cornea was present and CXL indicated. We performed epi-off dresden protocol CXL . After 6 months right cornea was crosslinked and 12 months follow up planned to decide next step. We found strong CXL effect, pachymetry over 500um, good BCVA and stable refraction, thus decided to perform low energy Relex Smile with 120/130um cap and 6,5/6,00mm lenticule. BCVA, UCVA, healing, refraction, pachymetry, front curvature and back surface elevation were observed.

Results:

before Relex right eyes manifest refraction was -4,75sph -1,0cyl ax 45 with BCVA 1,0, central pachymetry 519um. Left eye -8,00sph -0,50cyl ax 65 with BCVA 0,8, central pachymetry 520um. Manifest refraction was treated, healing normal. UCVA got to preop BCVA level within one moth and reached 1,0/0,9 refraction of right eye was +0,25sph +0,5cyl ax 8 and -0,50sph -0,50cyl ax 177 on the left. UCVA and refraction on the right side stayed stable, on the left UCVA decreased to 0,8 and refraction changed to -1,00sph -0,75cyl ax 155. Both corneas showed very stable curvature, pachymetry and back surface elevation.

Conclusions:

This case shows that the concept of management of suspicious corneas by creating strong anterior stroma by means of CXL first and than treating myopia by flapless ReLEx surgery protects anterior stiff crosslinked stroma to support and keep new corneal shape, thus preserves conditions leading to stable results instead of ingniting ectasia proces. Long term follow up of more such cases in a multicentric study is necessary to prove safety and unify parameters like cap thickness, lenticule diameter and limits for such procedure like preop pachymetry, stage of keratokonus changes, BCVA etc.

Financial Disclosure:

None