[Is there a role for Excimer laser in the treatment of keratoconus?]

In advanced keratoconus, when contact lenses become intolerant or provide insufficient vision, the only current available treatment is penetrating keratoplasty. But getting a graft takes a long time; we evaluated the eventual role of Excimer laser in taking care of those patients.

We present a series of 8 advanced keratoconus, at that time, intolerant to contact lens because of a major ectasia and/or apical opacities. An excimer photoablation, using the therapeutic or rarely the refractive one, was performed in order to flatten or resurface the cornea, allowing a new contact lens fitting.

We noted no complication, except a denser and longer postoperative haze. Thanks to a good compliance, 4 patients benefited from a new contact lens fitting, leading to an optimal visual recovery. On the other hand, in 3 cases, a corneal graft had to be performed, without any side effect. An anatomo-pathologic analysis was achieved on the 3 corneal caps, giving some precisions about tissular changes.

Excimer laser, under its therapeutic approach, might be an efficient treatment for advanced keratoconus, in conditions of cautious indications selection and of an inevitable coupling to contactology. Then, this surgery could delay or even avoid penetrating keratoplasty.