Femto-CKT procedure shows promise for keratoconus stabilization

Take-home message: Keratoconus in eyes with stage I or II disease has remained stable during follow-up to 2 years after circular keratotomy performed using a femtosecond laser.

Reviewed by Detlev R.H. Breyer, MD

Düsseldorf, Germany-Circular keratotomy performed with a femtosecond laser (“femto-CKT”) is a safe, effective, and efficient method for stopping keratoconus progression in eyes with earlier-stage disease, suggest results from follow-up to 1.5 years.

In addition, the treatment benefit occurs regardless of patient age, said Detlev R.H. Breyer, MD, owner and leading anterior segment surgeon, Breyer-Kaymak-Klabe Augenchirurgie, Düsseldorf, Germany.

More about femto-CKT

The procedure is a modern refinement of circular keratotomy. Rather than making a penetrating dissection with a trephine knife, femto-CKT uses a proprietary femtosecond laser (Femto LDV Z6, Ziemer) to create an intrastromal cut without intended perforation of Bowman Descemet membrane. The procedure aims to stabilize the corneal surface using the keratotomy to isolate the central cornea and anticipating that the scar will act as a stabilizing ring.

Related: Keratoconic eye experience with a long-arc intrastromal corneal ring

Dr. Breyer, along with Jörg Krumeich, MD, Bochum, Germany, and Thomas Neuhann, MD, Munich, Germany, came up with the specific parameters for a femto-CKT. They aimed to achieve the efficacy of the original procedure combined with the potential advantages of making an intrastromal cut with the femtosecond laser without the need for a double-running suture.

“We were unsure at first whether the femtosecond laser cut would create an intrastromal scar that could stabilize the cornea,” Dr. Breyer said. “We reasoned, however, that the procedure could be completed faster using the femtosecond laser and we expected that keeping the cut within the stroma would minimize risk of infection, result in less postoperative pain, and might avoid the need for a double-running suture.”

Related: Using femtosecond lasers in eyes with previous surgery

“With anterior segment OCT, we have demonstrated that femto-CKT results in an intrastromal scar, and the clinical outcomes are promising,” he added.

However, outcomes in more eyes and with a close longer follow-up is definitely needed to determine the safety and efficacy of the procedure and the longevity of keratoconus stabilization, he noted.

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