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Phototherapeutic keratectomy versus manual epithelial debridement on cross-linking procedures for progressive keratoconus

Poster Details

First Author: M.Santos PORTUGAL

Co Author(s):    A. Rosa   A. Martins   J. Gil   C. Tavares   M. Quadrado   J. Murta     

Abstract Details

Purpose:

To present and compare the outcomes of patients using two different techniques for epitelial removal prior to corneal collagen crosslinking (CXL) on progressive keratoconus: manual epithelial debridement or phototherapeutic keratectomy (PTK).

Setting:

Department of Ophthalmology, Centro Hospitalar e Universit�Ã�¡rio de Coimbra (CHUC), Coimbra - Portugal

Methods:

Analysis of 18 eyes (62,5% male, 37,5% female) with an average age of 20,94 years (range: 15 to 25 years) that underwent epithelial ablation via PTK or manual epithelial debridement prior to CXL with riboflavin and ultraviolet light A. In the PTK group (group 1, n = 8) epithelial removal was performed via PTK set at 50 �Î�¼m, and in the manual debridement group (group 2, n = 10), epithelial debridement was performed using sharp scalpel blades. The visual, refractive and topographic records were reviewed preoperatively and at 1, 3 and 6 months postoperatively.

Results:

In group 1 the mean best corrected visual acuity (BCVA) improved from 0,44�Â�±0,13logMAR to 0,16�Â�±0,06logMAR after 6 months. The mean steep and mean flat keratometry readings decreased from 53.90�Â�±4,13D and 46,60�Â�±2,22D to 50.35�Â�±2.53D (p < 0.05) and 45,17�Â�±1,44D respectively. The mean corneal astigmatism improved from 7.32�Â�±2,40D to 5.13�Â�±1,21D (p < 0.05) at 6 months postoperatively. In group 2 the mean BCVA at baseline was 0,40�Â�±0,26logMAR and 0,42�Â�±0,22logMAR at the last follow-up. The mean step and mean flat keratometry readings and the mean corneal astigmatism changed from 54.18�Â�±3,85D, 49,68�Â�±3,24D and 4,51�Â�±1,98D to 55,53�Â�±5,51D, 49,48�Â�±3,10D and 6.05�Â�±2.83D respectively, at 6 months postoperatively.

Conclusions:

Excimer laser transepithelial PTK, frequently used as a method for eliminating superficial corneal pathology, has also been employed for removing the epithelial layer prior to CXL. The current study showed that laser epithelial removal during CXL results in better visual, refractive and topographic outcomes. Combined transepithelial PTK and CXL was effective and safe in patients with progressive keratoconus, suggesting the superiority of this procedure comparing to mechanical epithelial removal.

Financial Disclosure:

NONE

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