Treatment of keratoconus with laser in situ keratomileusis, photorefractive keratectomy, and radial keratotomy

BACKGROUND: The authors investigated the refractive treatment of keratoconus to give patients better and more comfortable vision with and without glasses or soft contact lenses. METHODS: Patients with spectacle-corrected visual acuity worse than 20/40 and conus apex greater than 350-mu m thick were treated. We used the Nidek EC-5000 excimer laser with a 130-mm plate and special multi-design masks for the conus treatment and the Chiron ALK microkeratome. Patients were followed for 2 years postoperatively. We also used sector radial keratotomy to treat keratoconus. RESULTS: The authors report the advantages of using these new techniques to treat keratoconus. Excimer laser ablation should be performed only when the cornea surrounding the conus is flat, so that it can join the ablated zone (small optical zone) forming a new flat shape, without regression, Ablation did not exceed 50 mu m with a 3- to 4-mm ablation diameter for up to -6.00 D myopic correction. CONCLUSION: The authors hope to avoid or delay the need for corneal transplant in keratoconus eyes, giving these patients better vision with and without glasses or soft contact lenses.