Outcomes of Conductive Keratoplasty Combined with Corneal Crosslinking in Advanced Ectatic Corneal Disease

Mazen M Sinjab; Roy S Rubinfeld; Kirsten Wagner; Edward C Parsons Jnr; Arthur B Cummings; Michael W Belin

doi:10.2147/OPTH.S259012

Outcomes of Conductive Keratoplasty Combined with Corneal Crosslinking in Advanced Ectatic Corneal Disease

Clin Ophthalmol. 2021 Mar 29:15:1317-1329. doi: 10.2147/OPTH.S259012. eCollection 2021.

Authors

Mazen M Sinjab^{1

2}, Roy S Rubinfeld^{3

4}, Kirsten Wagner^{5

6}, Edward C Parsons Jnr⁷, Arthur B Cummings⁸, Michael W Belin⁹

Affiliations

¹ Dr. Mazen Eye Clinic, Medcare Hospitals and Centres, Dubai, United Arab Emirates.
² Al Zahra Medical Group, Damascus, Syria.
³ Department of Ophthalmology, Georgetown University Medical School/Washington Hospital Center, Washington, DC, USA.
⁴ Re:Vision Private Practice, Rockville, MD, USA.
⁵ Department of Ophthalmology, Medstar Georgetown University Hospital, Washington, DC, USA.
⁶ Department of Ophthalmology, Medstar Washington Hospital Center, Washington, DC, USA.
⁷ CXL Ophthalmics, Encinitas, CA, USA.
⁸ Wellington Eye Clinic, Dublin, Ireland.
⁹ Department of Ophthalmology, University of Arizona, Tucson, AZ, USA.

Abstract

Purpose: To assess the effectiveness of a novel treatment for patients with advanced corneal ectasia and loss of visual acuity (VA). Conductive keratoplasty (CK) is performed to improve VA followed by epithelium-on (epi-on) corneal crosslinking (CXL) to stabilize the cornea after CK.

Methods: Retrospective, exploratory cohort study. Patients with keratoconus or postsurgical ectasia and best spectacle-corrected distance VA (CDVA) ≤ 20/40 were included. Conductive keratoplasty was performed (ViewPoint CK System, Refractec, Inc., Bloomington, MN); followed a day later by epi-on CXL (CXLUSA/CXLO, Bethesda, MD/CXLO Encinitas, CA). Measures included uncorrected distance visual acuity (UDVA) and CDVA, as well as refractive and tomographic measures and tomographic indices.

Results: Data from 50 eyes of 45 patients were analyzed. Mean follow-up was 15.1 ± 12.2 months (range: 2 to 51). Overall, UDVA and CDVA improved postoperatively. Subjective refraction and tomographic metrics did not show consistent changes, but changes in tomographic indices were associated with treatment follow-up time. At the 1-year visit, mean UDVA significantly improved over baseline (P = 0.009) by approximately 3 lines; mean CDVA improved significantly (P = 10^-5) by approximately 2 lines. No eye lost lines of CDVA. Change in the Index of Surface Variance (ISV) was associated with treatment, and the D-Index trended over follow-up time.

Conclusion: Conductive keratoplasty with a proprietary epi-on CXL treatment improved vision in patients with advanced ectasia This CK/epi-on CXL treatment offers the possibility of improved VA for patients with compromised vision due to ectasia.

Keywords: CK; conductive keratoplasty; corneal crosslinking; crosslinking; ectasia; keratoconus; thermokeratoplasty.