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Refractive outcomes of topography-guided photorefractive keratectomy with simultaneous cross-linking for keratoconus

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Session Details

Session Title: Interactive Poster Session 03: Refractive

Session Date/Time: Monday 15/09/2014 | 14:00-15:00

Paper Time: 14:10

Venue: Interactive Poster Terminal (Poster Village)

First Author: : D.Lin CANADA

Co Author(s): :    S. Holland   G. Moloney   J. Tan        

Abstract Details


Evaluate refractive outcomes, efficacy and safety of simultaneous topography-guided photorefractive keratectomy (TG-PRK) with collagen cross-linking (CXL) for keratoconus (KC) using a neutralization technique and determine degree of hyperopic effect of CXL induced keratometric flattening after first year


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Epithelial removal by trans-epithelial laser, riboflavin 0.1% until aqueous staining, UV irradiation 370nm 8-15 minutes, 3mW/cm2 - 5.4 J/m2 , hypotonic riboflavin if less than 400um, bandage contact lens, standard post PRK management Degree of refractive correction based on residual stromal depth of 300 microns with target correction of -1.25 diopters (D). Symptom score (10 point) , uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), keratometry (K), efficacy, and safety were at 12 months.


215 eyes completed 12 months follow-up. 102 eyes (47%) had UCVA of 20/40 or better. 36 eyes (17%) had UCVA of 20/25 or better. 118 eyes (55%) had BSCVA improved, 47 eyes (22%) gained 2 lines or more, 13 eyes (6%) lost 2 lines or more. Average symptom score improved from 6.7 to 4.2 Mean reduction of astigmatism was 1.52 diopters (D). Complications included 7 with delay in epithelial healing, 4 with subsequent haze, 2 sufficient to reduce BCVA more than 2 lines, with one undergoing keratoplasty. One developed herpetic keratitis recovering pre-operative BCVA after PTK.


Early satisfactory refractive outcomes were obtained with simultaneous topographically-guided PRK with CXL. Progressive hyperopia probably related to cross linking, sufficient to be visually significant, occurred in 4 eyes. At one year follow-up, close to half of the eyes achieved UCVA of 20/40 or better and a half improved BSCVA

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