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    The future of keratoconus treatment

    Barcelona, Spain— Despite the advent of advanced technologies—such as corneal stromal collagen crosslinking (CXL), intracorneal ring segments (ICRS), toric phakic and pseudophakic IOLs, and keratoplasty—patients with keratoconus are mostly being managed with spectacles and/or contact lenses.

    The combination of stabilization techniques with various forms of CXL (mostly epi-off) with transepithelial PRK and/or ICRS and/or phakic IOLs is a robust strategy that may eliminate the need for keratoplasty in patients with keratoconus, according to Jose Guell, MD, PhD.

    More in this issue: What to tell your patients about MIGS

    However, there are no long-term data for any of these approaches. 

    “The current unique indication for CXL is cone stabilization in patients with keratoconus,” said Dr. Guell, associate professor of ophthalmology, Universidad Autonoma de Barcelona, and director, Cornea and Refractive Surgery Unit, Instituto de Microcirugia Ocular de Barcelona, Barcelona, Spain.

    The side effects of the procedure include central corneal flattening and irregularity index improvement with improvement of the best-corrected visual acuity that may become future new indications for CXL, but cone stabilization currently is the only indication, he explained.

    Research into the results of CXL has been limited and there are no long-term data, except for the Dresden and Siena protocol, extending out to 10 years.

    The classic epi-off CXL protocol that uses riboflavin and ultraviolet light is the only one for which there are outcomes for 5 or more years. Questions remain about the efficacy and safety profiles of CXL with different energy levels for different durations, as well as the efficacy profiles of transepithelial approaches.

    NEXT: Transepithelial CXL

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