Outcomes of a New Microwave Procedure Followed By Accelerated Cross-linking for the Treatment of Keratoconus: A Pilot Study

Abstract

To analyze the initial data obtained in a group of patients treated with microwave keratoplasty followed by accelerated corneal collagen cross-linking (CXL) for the correction of keratoconus. Prospective, nonrandomized clinical study including six eyes from four patients treated with microwave thermal keratoplasty followed by accelerated CXL. Refractive, topographic, anterior aberrometry, and corneal biomechanics outcomes were analyzed during 6-month follow-up. Immediately after the procedure, a significant reduction of >7.00 diopters (D) was observed in mean keratometry (P=.02). Uncorrected distance visual acuity increased from 0.92±0.52 logMAR (Snellen 20/160) preoperatively to 0.47±0.19 logMAR (Snellen 20/60) postoperatively (P=.05). No statistically significant change was found in corrected distance visual acuity (P=.28). Corneal higher order aberration decreased from 1.89±0.90 to 1.51±0.65 μm and corneal primary coma aberration decreased from 1.45±0.68 μm preoperatively to 0.84±0.23 μm postoperatively (P>.10). No statistically significant changes were found in the biomechanics variables (P=.40). A significant regression of the effect was assessed in keratometry at the end of follow-up (P=.03). The Keraflex procedure may have the ability to improve refractive status in patients who suffer from keratoconus, as well as induce corneal remodeling to a more anterior regular surface. However, the current treatment regimen is not sufficient to maintain the flattening effect achieved and significant regression occurs.