Subtractive Procedures Plus Corneal Crosslinking

Another possibility, successfully used for over a decade, is expanding the refractive therapeutic options for corneal ectasias, placing itself precisely between the end or the impossibility of using RGP contact lenses and the execution of a keratoplasty which in this way can be avoided or postponed, is represented by minimally selective trans-epithelial photorefractive (t-PRK) or phototherapeutic (t-PTK) keratectomy combined with conventional and accelerated CXL, in the so-called CXL Plus therapy. 

The aim of these treatments is to regularize corneal shape improving the quality of vision with spectacles, consuming the smallest amount of tissue, minimizing invasiveness. Despite that tissue ablation in KC corneas has never been widely and definitely accepted, it represents a therapeutic reality performed in many Countries in selected cases which needs to find a precise and shared place in the modern therapeutic flowchart of KC.

Mazzotta-D’Oria Flow Chart for CXL and CXL Plus Therapy