Corneal CXL to Treat Progressive Astigmatism Caused by Intrastromal Arcuate Incisions
Narrative Responses:
Purpose
To report the results of riboflavin and ultraviolet-A (UVA) corneal crosslinking in a patient with progression of astigmatism following intrastromal arcuate incisions.
Methods
This is a prospective study of a 54-year-old male treated with intrastromal arcuate incisions for myopic astigmatism with femtosecond laser at the time of cataract extraction/intraocular lens placement. Pre-operatively, the keratometric (K) readings were 44.88D and 43.71D with a manifest refraction (MR) of -6.50 -0.75 x055 OD. Twenty-one months after the procedure, the patient had progressive corneal astigmatism and a flipped cylindrical axis with K readings of 47.46D and 41.20D and best corrected visual acuity (BCVA) of 20/20 with an MR of +2.75 -6.00 × 130 OD. A treatment of riboflavin-UVA corneal crosslinking was performed on the right eye. The patient was followed for a period of two months. Main outcome measures were corneal topography, K readings, and BCVA with MR.
Results
At post-operative corneal crosslinking month 2, the keratometric readings were 50.07D and 40.85D. Placido imaging demonstrated increase in corneal astigmatism. Best corrected visual acuity was 20/200 with a manifest refraction of +1.00 -1.50 x150 OD.
Conclusion
Corneal crosslinking with riboflavin and UVA had no effect on the biomechanical stability of the cornea and was not a therapeutic means to arrest or reverse the progression of iatrogenic astigmastim due to intrastromal arcuate incisions in this patient.