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Simultaneous PRK /PTK and accelerated corneal collagen cross-linking for keratoconus and post-LASIK ectasia

Poster Details

First Author: J.Guo USA

Co Author(s):    E. Chynn   C. Beyer   J. Lin        

Abstract Details

Purpose:

Besides maintaining corneal biomechanical stability to prevent the recurrence and progression of keratoectasia, the treatment of keratoconus and post-LASIK ectasia would ideally also address the concomitant refractive error of the irregular cornea. The goal of our study was to assess whether simultaneous PRK/PTK and accelerated cross-linking is a safe and effective technique to provide both corneal stability and functional visual improvement.

Setting:

BoulderEyes,Beyer LASIK

Methods:

Eight eyes (7 patients) with progressive keratoconus and 2 eyes (2 patients) with LASIK-induced ectasia were treated. Five eyes (3 keratoconic and 2 post-LASIK) were treated with photorefractive keratectomy (PRK). Five keratoconic eyes were treated with phototherapeutic keratectomy (PTK). PRK or PTK was followed immediately by accelerated corneal collagen cross-linking (CXL) with 20 drops of 0.1% hypotonic riboflavin (1 drop every 30 sec) followed by UVA light exposure at 25 mW/cm2 for 6 sessions of 30 seconds each. Pre-and postoperative evaluation included uncorrected vision acuity (UCVA), best corrected vision acuity (BCVA), manifest refraction and corneal topography.

Results:

At 1 week, UCVA improved from logMAR 1.05 (+/- .21) to 0.48 (+/- .11; p <0.05) or 5 lines of Snellen improvement, with preservation of BCVA (preop logMAR 0.32, postop .29). At 1 month, UCVA was stable (logMAR .45 +/- .19), and BCVA improved to logMar .036 (+/- .003), or a 3 line improvement. Mean sphere improved from -3.04D (+/- 1.14) to -1.75D (+/- .75) and cylinder improved from -1.71D (+/- .34) to -1.04D (+/- .30) at 1 month. K1 decreased from 45.2 (+/- 1.3) to 42.4 (+/- .68) and K2 from 47.3 (+/- 1.3) to 45.0 (+/- 1.6).

Conclusions:

Simultaneous PRK/PTK and accelerated corneal cross-linking is a safe and effective therapy that reduces maximum and mean keratometry, which indicates flattening and associated strengthening of corneal tissue, with reduction of spherocylindrical refraction and improvement of visual acuity in patients with progressive ectasia. Longer follow-up is necessary to demonstrate long-term stability and visual function. FINANCIAL INTEREST: NONE.

Financial Disclosure:

NONE

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