Combining collagen CXL with intacs

Boston-Combination therapy of collage crosslinking (CXL) and corneal implants (Intacs, (Addition Technology) may be a good treatment for mild-to-moderate keratoconus, according to David Rootman, MD.

The segments originally were implanted to treat low myopia, and in 1997, were first used to treat keratoconus. Dr. Rootman  said he and his colleagues at the University of Toronto began using the SK segments with a smaller radius of curvature about 10 years ago. In their patients, the uncorrected and best-corrected visual acuities (UCVA, BCVA) improved, with most patients achieving better than 20/60 manifest refraction. The implants were found to work best in patients with mild-to-moderate keratoconus, underscoring the importance of patient selection.  

Collagen CXL has been seen repeatedly to stabilizes and even improves the corneal curvature, he said.

The best approach to the combination treatment was thought to be application in one step, rather than in two separate steps, Dr. Rootman explained.

The results indicated that in all cases, the UCVA and the BCVA levels improved alone and in combination with collagen crosslinking.

“What is notable is that with the combination treatment, there seemed to be a more rapid recovery of good VA,” he said.

When single and dual Intacs with CXL was investigated, Dr. Rootman said he saw a significant increase in the UCVA and the BCVA returned to normal in most cases.

“Crosslinking and Intacs do work together,” Dr. Rootman said. “This is a good treatment modality to consider for patients with mild-to-moderate keratoconus.”

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