Abstract
Purpose To evaluate the visual, refractive, and topographic outcomes after simultaneous topography-guided transepithelial photorefractive keratectomy (transepithelial TG-PRK) using the Amaris Excimer laser platform and accelerated corneal cross-linking (CXL) in eyes with keratoconus. Materials and Methods Patients with 2 years of follow-up were included in this retrospective case series. Manifest refraction (MR), uncorrected (UDVA) and corrected (CDVA) distance visual acuity, corneal topography, and pachymetry were evaluated at 1, 3, 6, 12, and 24 months after surgery. The root-mean-square of total higher-order aberrations (total HOA-RMS), coma (Coma-RMS), and spherical aberration (SA-RMS) were calculated for 4- and 6-mm diameters. Results Forty-six eyes of 46 patients were included in the study. Stromal ablation was ≤50 μ in all patients. MR was −3.78±3.26 preoperatively and −1.39±1.82 postoperatively. Significant improvements were seen in the UDVA and Coma-RMS values at 1 month, CDVA and total HOA-RMS values at 3 months, and SA-RMS values at 1 year compared to preoperative levels. UDVA values further improved after 2 years, compared to the 1-year values. No patient lost two or more lines and keratoconus progression was not observed in any patient. Conclusion Simultaneous transepithelial TG-PRK and accelerated CXL resulted in significant gains in CDVA without compromising CXL efficacy.
Highlights
Keratoconus is a noninflammatory ectatic disease of the cornea that results in localized corneal thinning and steepening
Significant improvements were seen in the UDVA and Coma-RMS values at 1 month, CDVA and total HOA-RMS values at 3 months, and SA-RMS values at 1 year compared to preoperative levels
Simultaneous transepithelial TG-photorefractive keratectomy (PRK) and accelerated CXL resulted in significant gains in CDVA without compromising CXL efficacy
Summary
Keratoconus is a noninflammatory (and usually bilateral) ectatic disease of the cornea that results in localized corneal thinning and steepening. Researchers developed accelerated CXL protocols that speed up the procedure using higher-intensity radiation for a reduced period of time; these protocols can be applied in various clinical settings and effectively stabilize keratoconus [3]. Various parameters have been used in these methods and no standard parameters for accelerated CXL have been established [3, 4]. Different excimer laser platforms have different ablation patterns and different algorithms for topography-guided ablation. Mechanical and laser debridement of the corneal epithelium (PRK versus transepithelial PRK) may result in different patterns of ablation and different clinical results. Clinical results with each excimer laser platform and each method of epithelial debridement should be examined separately
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