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Selective-transepithelial-ablation for regularization of ectasia with simultaneous accelerated cross-linking: the STARE-X protocol

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Session Details

Session Title: Advanced Surface Photoablation

Session Date/Time: Tuesday 10/10/2017 | 09:00-10:20

Paper Time: 10:07

Venue: Room 4.1

First Author: : M.Rechichi ITALY

Co Author(s): :    C. Mazzotta                    

Abstract Details


To evaluate the changes in refractive outcomes, corneal aberrations, and biomechanics after Selective transepithelial topography-guided photorefractive keratectomy with dynamic cyclotorsion control (DCC) combined with accelerated corneal collagen cross-linking (ACXL).


Eye Center, Catanzaro, Italy Siena Crosslinking Center


50 eyes underwent selective topography-guided transepithelial PRK followed by accelerated CXL using riboflavin A and enhanced-intensity (15 mW/cm2, 7.2 J) ultraviolet light. Outcome parameters included uncorrected distance visual acuity (UCVA) and best spectacle corrected visual acuity (BSCVA). Corneal tomography and corneal wavefront aberrations were assessed before and a year after the procedure. Eyes were subdivided into 2 groups preoperatively for statistical analysis: Group 1 with cone located within the central 3-mm zone (25 eyes); and Group 2 (25 eyes) with cone located outside the central 3-mm zone. Follow-up was one year for all eyes.


UCVA, BSCVA, sphere, cylinder, and simulated keratometry improved after treatment in both groups (P < 0.05). However, BDVA improved more in Group 1 than in Group 2 (P <0.05) and the other variables were not affected by cone location. There was significant improvement (P <0.05) in coma and corneal asymmetry aberration in group 2. Corneal wavefront Zernike aberrations changed after treatment (P < .05) but none were affected by cone location (P > .05). No adverse effects was observed.


The STARE-X protocol demonstrated effective results in halting keratoconus progression improving corneal regularity with a safe and effective profile. STARE-X improved both visual acuity and corneal aberration in the mid-term period. The effects were more evident in peripheral cone. Longer follow-up is need to confirm these results and observe long-term cxl flattening effect on the cone.

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