Case 1 describes a 35-year-old man with progressive keratoconus (PK). His best corrected visual acuity (BCVA) was right 20/80 (-5.25/-7.75 x 85) and left 20/20 (+4.75/-5.00 x 90). His Ks were right 36.32/48.02 D and 41.15/46.41 D. Right central cornea thickness (CCT) was 327um and left 474um. There was no history of atopy or eye rubbing. In his right eye he had a PK and left eye corneal collagen crosslinking (CXL). Six months later BCVA left eye was 20/20 (+2.50/-3.50 x 100), Ks were 40.48/45.67 D. Three years later BCVA was 20/20 (+2.50/-3.25 x 100). However, there was an increase in Ks (42.74/47.36) i.e. >1.00D. Case 2 was a 29-year-old man with progressive keratoconus. His BCVA was right 20/25 (manifest refraction -1.75/-2.25 x75) and left 20/25 (manifest refraction -3.00/-1.25 x25). Ks were 41.87/43.92D right eye and 40.20/43.28D right eye. Five years later there was an increase in topographic steep K in the left eye, 40.96/45.82 by >1D, the manifest refraction was +0.75/-2.25 x 15. The right eye remained stable. Several studies have reported continued progression of keratoconus in the first year after treatment. These cases report topographic of > 1D progression after >four years post treatment without a reduction in BCVA. The mechanism behind this is not discussed in the report. The area of CXL corneal tissues remodels and regains original thickness > four years on. If the progression of ectasia continues resulting in reduction in BCVA would repeat CXL be an option if there is enough residual stromal tissue? Repeat CXL have been carried out by Seiler and others in women with progressive ectasia following hormonal changes associated with pregnancy. Kanellopoulos has re-treated patients who were first treated with epithelium on. Daya has retreated in post LASIK ectasia.
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- Topography based keratoconus progression after corneal collagen cross-linking
