Abstract
BackgroundTo investigate the effects of combined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK) and accelerated corneal collagen cross-linking (CXL) after intracorneal ring segment (ICRS) implantation in patients with moderate keratoconus.MethodsMedical records of 23 eyes of 23 patients undergoing combined tPRK and CXL after ICRS implantation were retrospectively analyzed. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal indices based on Scheimpflug tomography, higher-order aberrations (HOAs), and corneal biomechanical properties were evaluated before and after ICRS implantation, and at 1, 3, and 6 months after combined tPRK and CXL.ResultsThere were significant improvements in final logMAR UDVA and logMAR CDVA, and reductions in sphere, MRSE, and all corneal indices from baseline. Significant improvements in logMAR UDVA and reductions in sphere, MRSE, maximal keratometry, keratometry at the apex, mean keratometry, and keratoconus index were noted after ICRS implantation. After tPRK and CXL, significant improvements in logMAR UDVA and logMAR CDVA, and reductions in cylinder and all corneal indices were observed. There were significant improvements in final root mean square HOAs and coma aberrations from baseline, but no changes from baseline after ICRS implantation. Significant reductions in final radius and deformation amplitude from baseline were noted.ConclusionsCombined tPRK and accelerated CXL after ICRS implantation in moderate keratoconus appears to be a safe and effective treatment, providing an improvement in visual acuity, corneal indices, and HOAs.Trial registrationretrospectively registered (identification no. NCT03355430). Date registered: 28/11/2017.
Highlights
To investigate the effects of combined corneal wavefront-guided transepithelial photorefractive keratectomy and accelerated corneal collagen cross-linking (CXL) after intracorneal ring segment (ICRS) implantation in patients with moderate keratoconus
The shortened treatment time is beneficial for patient comfort and combination of the approach with other therapies including transepithelial photorefractive keratectomy, laser in situ keratomileusis (LASIK), or PRK and single intrastromal ring segment implantation for keratoconus treatment [9, 14,15,16]
A study investigating the effect of topography-guided PRK and Collagen cross-linking (CXL) after ICRS implantation in patients with low to moderate keratoconus has demonstrated that uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry values, and coma aberrations were significantly improved at 6-months postoperatively [28]
Summary
To investigate the effects of combined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK) and accelerated corneal collagen cross-linking (CXL) after intracorneal ring segment (ICRS) implantation in patients with moderate keratoconus. A study investigating the effect of topography-guided PRK and CXL after ICRS implantation in patients with low to moderate keratoconus has demonstrated that uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry values, and coma aberrations were significantly improved at 6-months postoperatively [28]. Coskunseven et al have reported that, in patients with progressive keratoconus, topography-guided tPRK, after ICRS implantation and followed by CXL, resulted in an improvement in logMAR UDVA, logMAR CDVA, manifest refraction spherical equivalent (MRSE), and mean steep and flat keratometry values [29]. Another study has reported that the combination of accelerated CXL and same-day transepithelial phototherapeutic keratectomy and single inferior ICRS is as effective as the combined treatment, using standard CXL, in terms of visual and topographical outcomes [9]
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