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First Author: A.Fadlallah LEBANON
Co Author(s): A. Dirani Z. Syed Z. Khoueir G. Cherfan F. Abi Nader E. Jarade
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To evaluate the safety and clinical outcome of photorefractive Keratectomy (PRK) for the treatment of residual mild refractive errors 6 months after sequential Intracorneal Ring segments (ICRS) and corneal collagen UVA cross-linking (CXL) in stable keratoconus.
University Hospital, Beirut Eye Specialist Hospital
A retrospective study examined the results of a 3-step (ICRS-CXL)/PRK in 6 eyes of 4 patients with mild to moderate keratoconus. The two procedures (ICRS-CXL) were performed sequentially at an interval of 4 weeks and PRK was performed at least 6 months after CXL. Data were collected preoperatively, at the 6-month follow-up visit after sequential ICRS-CXL, and at the 6-month follow-up visit after PRK.
ICRS-CXL induced a significant decrease in keratometry, increase in visual acuity and decrease in refraction. At 6-month follow-up after ICRS-CXL, mean Kflat was 44.12ḟ2.23 D vs. 46.23ḟ2.07 D preoperatively (p=0.01) and mean Ksteep was 47.37ḟ3.07 D vs. 50.29ḟ2.23 D preoperatively (p=0.01). Uncorrected distance visual acuity (UCVA) significantly improved from 1.26 ±0.38 logMAR before ICRS-CXL to 0.49 ±0.12 logMAR 6 months after (p = 0.028) and corrected distance visual acuity (CDVA) significantly improved from 0.41 ±0.11 logMAR to 0.16ḟ0.07 logMAR (p=0.01). The mean spherical error decreased from -5.45 ±2.37 D to -2.5 ±1.41 D (p=0.01), and the mean cylinder from 4.08 ±1.1.36 D to 2.25 ±1.49 D (p=0.001). At 6-month post PRK, UCVA improved significantly to 0.15ḟ0.05 logMAR and the CDVA was 0.12 ±0.05 logMAR. The safety and efficacy indices of PRK after ICRS-CXL were1.11ḟ0.14 and 1.04ḟ0.15 respectively. The mean spherical error decreased significantly to -0.87 ±0.46 D (p=0.02), and the mean cylinder decreased significantly to 0.91 ±0.20 D (p=0.04). No intraoperative or postoperative complications occurred.
Photorefractive keratectomy after sequential Intracorneal Ring Segments and corneal collagen cross-linking is an effective and safe option for correcting residual refractive error and improving visual acuity in patients with moderate keratoconus.