KERATOCONUS MANAGEMENT WITH CUSTOMIZED CROSSLINKING COMBINED WITH TOPOGRAPHY-GUIDED PHOTOREFRACTIVE KERATECTOMY

Published 2022 - 26th ESCRS Winter Meeting

Reference: FP97 | Type: Abstracts | DOI: 10.82333/kqk2-d610

Authors: Joao Quadrado Gil ¹ , Sara Baptista* ² , Joao Chaves ² , Esmeralda Costa ³ , Andreia Rosa ¹ , Cristina Tavares ² , Maria Joao Quadrado ¹ , Joaquim Murta ¹

¹Ophthalmology,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Ophthalmology,Unidade de Oftalmologia de Coimbra,Coimbra,Portugal;Faculty of Medicine,University of Coimbra,Coimbra,Portugal, ²Ophthalmology,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal, ³Ophthalmology,Centro Hospitalar e Universitário de Coimbra,Coimbra,Portugal;Faculty of Medicine,University of Coimbra,Coimbra,Portugal

Purpose

Corneal cross-linking (CXL) is an evolving therapy for the treatment of progressive keratoconus (KC). Conventional treatments have shown to be able to stabilize progression but its inability to improve vision is an important insufficiency. Various treatment combinations have been proposed and reported extensively to improve outcomes.Some protocols include combining a partial topography-guided surface ablation with CXL. Costumized irradiation protocols are also purported to provide greater localized flattening.We report on the outcomes of a treatment protocol combining partial topography-guided normalization and customized corneal crosslinking (CXL) for the treatment of keratoconus.

Setting

Unidade de Oftalmologia de Coimbra (UOC), Coimbra, Portugal

Methods

Prospective interventional case series. Consecutive patients with progressive keratoconus underwent a combined treatment protocol that included a 50 µm phototherapeutic keratectomy epithelial debridement followed by a topography-guided partial PRK treatment of maximum 50 µm. The corneas were then irradiated using a customized profile designed as the superposition of 3 concentric areas centered on the thinnest point. The treatment starts from a baseline broad-beam illumination including the flattest peripheral area and then is continuously masked until only the central inner circle is irradiated. Energy exposure is 5.4J/cm 2 in the outer circle and then increases centripetally to 7.5 J/cm 2 and 10 J/cm 2.

Results

Six eyes from 6 patients, mean age 29.3±7.9 years, with an average central corneal thickness of 468.3 mm, were included. Mean CDVA improved from 0.37 at baseline to 0.15 logMAR, over a postoperatively mean follow-up of 14.00 ± 2.87 months. All patients gained 2 or more lines of vision with no patient presenting with loss of lines. Mean refractiev astigmatism improved from 3.5 D to 2.4 D, with a maximum reduction of 3.5 D observed. The maximal curvature (KMax) improved from 56.02±3.10 to 50.80±2.11 and steep keratometry reading (K2) from 49.85±1.19 to 48.77±2.27. None of the patients developed significant complications during the course of the follow-up, with reepithelialization being achieved within one week postoperatively for all patients.

Conclusion

This pilot study showed a significant improvement in visual acuity and refractive astigmatism, while achieving simultaneous stabilization of disease progression. A combined approach that incorporates customized cross-linking stabilization and refractive normalization with PRK can provides us with new therapeutic option in KC cases.