Transepithelial crosslinking retreatment of progressive corneal ectasia unresponsive to classic crosslinking.
A 41-year-old man presented 10 years after uneventful laser in situ keratomileusis (LASIK) with symptomatic post-LASIK ectasia. He had treatment with the classic Dresden epithelium-off technique and presented 4 years later with progression of the ectasia. He was subsequently retreated with conductive keratoplasty (CK) followed by a new proprietary epithelium-on corneal collagen crosslinking (CXL) procedure using a proprietary transepithelial riboflavin formulation and delivery system on the following day. One year after retreatment, the patient noted stable vision in the treated eye with a corrected distance visual acuity (CDVA) of 20/60+. Thus, epithelium-on CXL, if performed with appropriate formulations and delivery technology as well as careful attention to appropriate riboflavin loading of the stroma, can stabilize an ectatic cornea. In addition, when performed prior to CXL, CK can induce a significant, lasting improvement in corneal shape and CDVA. This technique merits further study.
From Georgetown University Medical Center (Rubinfeld) and Washington Hospital Center (Rubinfeld), Washington, DC, Re: Vision (Rubinfeld, Kim, Choi), Rockville, Maryland, and Fairfax, Virginia, Department of Ophthalmology (R.H. Epstein, Majmudar, R.J. Epstein), Rush University Medical Center, and Chicago Cornea Consultants, Ltd. (Majmudar, R.J. Epstein), Chicago, Illinois, USA.
Roy S
RS
Rubinfeld
From Georgetown University Medical Center (Rubinfeld) and Washington Hospital Center (Rubinfeld), Washington, DC, Re: Vision (Rubinfeld, Kim, Choi), Rockville, Maryland, and Fairfax, Virginia, Department of Ophthalmology (R.H. Epstein, Majmudar, R.J. Epstein), Rush University Medical Center, and Chicago Cornea Consultants, Ltd. (Majmudar, R.J. Epstein), Chicago, Illinois, USA.
Rachel H
RH
Epstein
From Georgetown University Medical Center (Rubinfeld) and Washington Hospital Center (Rubinfeld), Washington, DC, Re: Vision (Rubinfeld, Kim, Choi), Rockville, Maryland, and Fairfax, Virginia, Department of Ophthalmology (R.H. Epstein, Majmudar, R.J. Epstein), Rush University Medical Center, and Chicago Cornea Consultants, Ltd. (Majmudar, R.J. Epstein), Chicago, Illinois, USA.
Parag A
PA
Majmudar
From Georgetown University Medical Center (Rubinfeld) and Washington Hospital Center (Rubinfeld), Washington, DC, Re: Vision (Rubinfeld, Kim, Choi), Rockville, Maryland, and Fairfax, Virginia, Department of Ophthalmology (R.H. Epstein, Majmudar, R.J. Epstein), Rush University Medical Center, and Chicago Cornea Consultants, Ltd. (Majmudar, R.J. Epstein), Chicago, Illinois, USA.
Deborah
D
Kim
From Georgetown University Medical Center (Rubinfeld) and Washington Hospital Center (Rubinfeld), Washington, DC, Re: Vision (Rubinfeld, Kim, Choi), Rockville, Maryland, and Fairfax, Virginia, Department of Ophthalmology (R.H. Epstein, Majmudar, R.J. Epstein), Rush University Medical Center, and Chicago Cornea Consultants, Ltd. (Majmudar, R.J. Epstein), Chicago, Illinois, USA.
Michael
M
Choi
From Georgetown University Medical Center (Rubinfeld) and Washington Hospital Center (Rubinfeld), Washington, DC, Re: Vision (Rubinfeld, Kim, Choi), Rockville, Maryland, and Fairfax, Virginia, Department of Ophthalmology (R.H. Epstein, Majmudar, R.J. Epstein), Rush University Medical Center, and Chicago Cornea Consultants, Ltd. (Majmudar, R.J. Epstein), Chicago, Illinois, USA. Electronic address: repstein@chicagocornea.com.
Randy J
RJ
Epstein
D000328:Adult; D003094:Collagen; D003315:Cornea; D003316:Corneal Diseases / Q000628:therapy; D004108:Dilatation, Pathologic; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods; D008297:Male; D019233:Retreatment; D012256:Riboflavin / Q000008:administration & dosage; D014792:Visual Acuity
D003094:Collagen; D012256:Riboflavin