Corneal Cross-linking for Keratoglobus Using Individualized Fluence

PURPOSE: To present a case of bilateral progressive keratoglobus that was successfully arrested with corneal cross-linking (CXL) applying the sub400 individualized fluence protocol. METHODS: Case report. RESULTS: A 36-year-old man with bilateral progressive keratoglobus and no history of eye rubbing presented with a corrected distance visual acuity (CDVA) of 20/200 in the left eye. Progression in the left eye was confirmed using previously taken corneal topographies and comparing them to high-resolution Scheimpflug imaging, high-speed dynamic Scheimpflug imaging, and anterior segment optical coherence tomography. Epithelium-off CXL was performed in the left eye using individualized fluence that was adapted to the thickness of the corneal stroma immediately prior to irradiation (sub400 protocol). Postoperative follow-up of 32 months showed stabilization of keratometric values and no endothelial cell loss. CONCLUSIONS: The sub400 epithelium-off CXL protocol using individualized fluence may arrest progressive keratoglobus and might represent a novel therapeutic approach for the management of keratoglobus. [ Journal of Refractive Surgery Case Reports. 2021;1(1):e10–e14.]