Presentation: Two Step Approach to Keratoconus.

1. By
Dr Waleed Al-Tuwairqi, MD
Elite Medical & Surgical Center
Riyadh -KSA
7th International Congress
Of Corneal Cross-Linking
2011
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2. ‫بسم ال الرحمن الرحيم‬
In the name of Allah, Most Gracious, Most Merciful
Saudi Desert Mecca
Riyadh Elite
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3.  Selecting the right patient for ICR
 Observing post-op results for 6-12 months
 Enhancing post-ICR results with PRK+CXL
 Reviewing the results of this approach
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4. KC
Terminal
KC Advanced - CS
KC Moderate - ICS
KC Moderate - BSV
KC Early - GSV
KC Suspect - ESV
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5. 1. BSCVA 20/20 or better
2. Corneal Coma < 0.5um
3. Post. Elevation < 15um
4. UNCVA for Near J1 or Better
5. Subjectively Patient easily can drive at night
6. Max K < 48 D
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6. 1. BSCVA 20/25 or better
2. Corneal Coma < 1.5um
3. Post. Elevation < 40um
4. UNCVA for Near J2 or Better
5. Subjectively Patient can drive at night
6. Max K < 51 D
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7. 1. BSCVA 20/40 or better
2. Corneal Coma 1.5-4.0um
3. Post. Elevation > 40um
4. UNCVA for Near J2 or Worse
5. Subjectively Night vision difficulty
6. Max K 48-55 D
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8. 1. BSCVA 20/50 or less
2. Corneal Coma > 4um
3. Post. Elevation > 60um
4. UNCVA for Near J3 or Less
5. Subjectively Symptomatic
6. Max K > 60 D
7. Cone Dimension 3*3 or 5*5
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9. G.S.V. B.S.V. I.C.S.
ICR (B.S.V.  G.S.V.)
PRK+CXL
&
Or ?
PRK+CXL
ICL+CXL
(Irregular central cornea  Regular central cornea)
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10. 7th International Congress of Corneal Cross-Linking
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11. 12
OD 6 KC 11
OS 6 Post-Lasik Ectasia 1
Eyes 12 Eyes 12
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12. Mean 30 y Males 11
Minimum 16 y Females 1
Maximum Eyes 12
43 y
Count 12 E
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13. 25Y. M. OS
Pre-ICR
Post-ICR
Post-PRK+ CXL
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14. 31Y. M. OS
Pre-ICR
Post-ICR
Post-PRK+ CXL
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15. 31Y. M. OD
Pre-ICR
Minor
Post-ICR
Change
Post-PRK+ CXL
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16. 28Y. M. OD
(Post-Lasik Ectasia)
Pre-ICR
Post-ICR
Post-PRK+ CXL
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17. 38Y. M. OS
Pre-ICR
Post-ICR
Post-PRK+ CXL
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18. 38Y. M. OD
Pre-ICR
Post-ICR
Post-PRK+ CXL
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19. 43Y. M. OS
Pre-ICR
Post-ICR
Post-PRK+ CXL
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20. 26Y. M. OD
Pre-ICR
Post-ICR
Post-PRK+ CXL
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21. 21Y. M. OS
Pre-ICR
Post-ICR
Post-PRK+ CXL
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22. 16Y. M. OS
Post-ICR
Pre-ICR
Post-PRK+ CXL
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23. 25Y. M OD
Pre-ICR
Post-ICR
Post-PRK+ CXL
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24. Pre-ICR Post-ICR Post-PRK-CXL
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25. Pre-ICR Post-ICR Post-PRK-CXL
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26. Pre-ICR Post-ICR Post-PRK-CXL
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27. Pre-ICR Post-ICR Post-PRK-CXL

28. Pre-ICR Post-ICR Post-PRK-CXL
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29. Pre-ICR Post-ICR Post-PRK-CXL

30. Pre-ICR Post-ICR Post-PRK-CXL

31. Pre-ICR Post-ICR Post-PRK-CXL

32. Pre-ICR Post-ICR Post-PRK-CXL

33. Difference between Difference between Difference between
Factor Pre-ICR & Post-ICR Post-ICR & Pre-ICR &
Post-PRK+CXL Post-PRK +CXL
UNCVA 0.38 0.23 0.61
(0.1 - 0.35) ( 0 - 0.3) (0.1 - 0.65)
BCVA 0.09 0.10 0.19
(-0.2 -0.2) (0 - 0.3) (-0.2 -0.5)
Spherical -3.06D -1.81D -4.88D
Equivalent (S.E.) (1.12 - 6.5) (-2.78 - 1) (-1.75 - 7.5)
Corneal -1.88D -0.02D -1.90D
Astigmatism (0.7 - 6.24) (0.07 - (-0.24)) (0.46 - 6.17)
Max K 3.23D 3.01D 6.25D
(1.96 - 5.73) (2.13-3.79) (5.75 - 7.86)
Average K 2.33D 3.56D 5.88D
(1.57 – 5.19) (3.47 – 5.58) (5.04 – 10.77)
Coma 0.66 0.32 0.98
(0.4-0.64) (-0.2 - 1.0) (0.2-1.64)
Ablation Depth 60um
(27 – 125)

34.  Based on our review, ICR followed later by
PRK+CXL is an effective & safe approach in
making a functional change in the life style of
cases of moderate KC
 We recommend to be done for the following
group of patients …..
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35. 1. MAX K 55D or less
2. Sphere -6D
3. Coma 1.5-4.0 u
4. Post. Elevation >??
5. Pachymetry 450 u or more
6. Clarity Clear cornea
7. Gain of lines 2 lines or more
(expect to achieve in 2nd step)
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36. Saudi Desert Mecca
Riyadh Elite
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