Abstract
BackgroundTo evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking (CXL) to strengthen the corneal tissue and stop the progression of keratoconus. The transepithelial therapeutic ablation applied a novel concept named central corneal regularization (CCR) which could correct the corneal morphological irregularities and the eye’s spherocylindrical refractive error with minimal stromal tissue removal.MethodsRetrospective study. Eyes that underwent CCR combined with CXL were evaluated preoperatively and up to 12 months postoperatively for visual acuity, subjective refraction, corneal haze, pachymetry and maximum keratometry (Kmax).ResultsTwenty four eyes of 24 patients with a mean age of 28.92 ± 9.88 years were treated. The mean spherical equivalent (SE) refractive error changed from − 0.74 ± 1.17 D preoperatively to − 1.05 ± 1.52 D at 12 months postoperatively. The mean uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) improved. No eye lost lines of CDVA, 21 had a mean improvement of 3.21 lines. The mean cylinder error and Kmax value dropped from − 3.06 ± 1.83 D and 51.38 ± 3.29 D to − 1.04 ± 0.80 D and 48.70 ± 2.58 D, respectively. The mean haze score at 3, 6 and 12 months was 0.56, 0.19 and 0.06, respectively.ConclusionsCCR combined with CXL offers promising results as a safe and effective treatment in keratoconic patients.
Highlights
To evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking (CXL) to strengthen the corneal tissue and stop the progression of keratoconus
The current study retrospectively evaluates the clinical outcomes using the outlined approach combined with CXL performed right after the central corneal regularization (CCR), within the same surgical session
A similar trend was observed when we evaluated the mean anterior higher order corneal morphological aberrations (HOCMAs) at 6 mm
Summary
To evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking (CXL) to strengthen the corneal tissue and stop the progression of keratoconus. In order to gain a better control of visual outcomes in addition to strengthening the cornea, CXL has been combined with other procedures such as laser vision correction, implantation of corneal ring segments, or use of phakic or aphakic intraocular lenses, improving eye optics. It seems that corneal surface ablation, performed in the same session as CXL or sequentially, has been the most popular of those procedures [1, 6, 7]. The combined treatment consisting of CXL preceded by a minimally invasive customized trans-epithelial corneal regularization seems to be a promising approach to freezing the keratoectatic process in an optically regularized cornea and achieving a potentially stable improvement of the quality of vision
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