At the annual meeting of the Brazilian Association of Cataract and Refractive Surgeons, BRASCRS 2025, held this year in São Paulo, Dr. Emilio Torres-Netto, MD, PhD, FWCRS, presented detailed insights into ELZA-PACE cross-linking. This technique offers a personalised approach for managing keratoconus. Dr. Torres-Netto works at the ELZA Institute in Switzerland and specialises in corneal surgery and biomechanics.

Limitations of Conventional Cross-Linking

Corneal cross-linking (CXL) effectively halts keratoconus progression by strengthening the cornea. However, traditional epi-off protocols often require additional procedures to improve corneal shape and vision. Visual rehabilitation rarely occurs with CXL alone.

The ELZA-PACE Method

ELZA-PACE uses excimer laser phototherapeutic keratectomy (PTK) with customised epithelial removal. An epithelial thickness map guides the selective removal of epithelium over the cone apex. This process creates a small “window” that allows better riboflavin penetration.

Most of the corneal epithelium stays intact, reducing discomfort and preserving the barrier function. This targeted approach optimises UVA irradiation to the steepest corneal areas.

Clinical Outcomes of ELZA-PACE

Dr. Torres-Netto shared data showing significant corneal regularisation. On average, the technique achieves 4 to 6 diopters of flattening. Some cases showed improvements exceeding 14 diopters. These changes often improve visual quality.

ELZA-PACE aims to stabilise the disease and improve corneal shape in one procedure.

Technological Requirements

Precision imaging and laser technology enable the personalised epithelial removal. This technology ensures that cross-linking energy targets the cone apex accurately. ELZA-PACE contrasts with conventional full epi-off methods by preserving corneal tissue.

Related Innovations at BRASCRS

Alongside ELZA-PACE, Dr. Torres-Netto discussed ECO-CAIRS (Extracorporeal Corneal Allogenic Intrastromal Ring Segments). These biologically compatible implants combine with customised cross-linking in keratoconus rehabilitation. This reflects the ELZA Institute’s comprehensive treatment philosophy.

Future Directions

While preliminary results are promising, larger prospective studies are needed. Longer follow-up will clarify the durability and patient selection for ELZA-PACE cross-linking. Ongoing research remains essential to refine this approach.

Press coverage

The Brazilian ophthalmology media organization, Ofthalmoflix, interviewed Dr. Torres on site to discover more about ELZA-PACE.