In this case with describe the successful management of severe progressive keratoconus in a young female patient(32yo at the time) who had become a penetrating keratoplasty candidate.
Following thorough discussion and informed consent the young lady opted to explore the possibility of performing our Athens protocol CXL instead or prior to a corneal transplant despite the fact that both corneas were under 400 µm in minimal cornea thickness.
Due to this particularity we were unable to treat with our standard topography-guided normalization that removes 50 microns over the cone, so with the EX500 excimer laser we performed the 50 Micron depth 7 1/2 mm diameter phototherapeutic keratectomy (PTK) that in essence due to the classic epithelial remodeling present in advanced KCN “shaved” 10 microns off the cone and performed a limited hyperopic PRK of 10-15 microns. Then followed with higher fluence cross-linking: specifically 6mW / cm2 for 15 minutes as per our standard Athens Protocol CXL .
The results three years later are very rewarding: keratoconus in both eyes is stabilized with good normalization of both corneas. Our patient is functioning very well with a soft toric contact lens in her right eye and a scleral lens in her left eye with CDVA 20/25!! In both
The advanced imaging illustrating this case details are discussed: thanks for watching
