Keratoconus
ICD-10 H18.6 · ICD-11 9A78.50

Keratoconus: Managing Progression When Collagen Cross-Linking Has Not Achieved Treatment Goals

For patients with progressive keratoconus in whom corneal cross-linking and adjunctive procedures have been attempted but have not delivered the expected visual or topographic response, a surgical approach targeting the cornea itself becomes the appropriate next consideration.

Previous Treatment & Failure Condition

Collagen cross-linking (CXL) with ultraviolet A and riboflavin — along with adjuncts including topography-guided photorefractive keratectomy and intracorneal ring segments (ICRS) — did not achieve the expected goals: an improvement in best-corrected visual acuity (BCVA) of 1 to 2 lines, or a reduction of maximum keratometry (Kmax) of 1 to 2 D.

Next-Line Approach

When less-invasive procedures have not been effective, the next step involves corneal transplantation. The specific procedure selected depends on the structural state of the cornea at the time of surgery. The complete protocol specifies the criteria for each option, the surgical approach, and perioperative considerations.

Instant Access to Structured Evidence-Based Regimens

References

  1. When less-invasive procedures are not effective, patients may require corneal transplantation.
  2. Penetrating keratoplasty (PK) for KC is an effective procedure with good visual outcomes.
  3. To preserve unaffected native endothelial cells, surgeons may perform a deep anterior lamellar keratoplasty (DALK) if the Descemet membrane has not been previously ruptured, as in hydrops.
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