Results Of Topo Guided Customised Ablation Therapy With Collagen Cross Linking For Keratoconus

collagen cross linking procedure only stabilises keratoconus and prevents its progression. this procedure does minimal to improve quantity and quality of vision of the patient. thus patients remains visually and psychologically disturbed and under perperformer. This study aims to study if by using simultaneous limited topo guided corneal ablation with collagen can not only stabilise keratoconus, preventy its progression but also improve refractive error and best corrected visual acuity so that patients become more confident and perform to their full potential

study was done in OPD of kahalekar super speciality eye hospital, Aurangabad india. Patients suspected to have underwent topographic analysis. after conforming diagnosis they were counselled properly about the possible benefits of the procedure and expected good and unwanted outcomes. due consent was taken and all required legal and regulatory formalities completed

patients having thinnest pachymetry of more than 450 microns underwent limited topo guided corneal ablation of not more than 50 microns leaving behind a minimum of 400 microns of thinnest pachymetry. this was then continued with collagen cross linking wherein cornea as soaked for 20 minutes in 0.1% Riboflavin dye instilled every 2 minutes and then followed by UV exposure for 10 miutes using accelerated collagen cross linking protocol. patients refraction and BCVA was studied at 1 month and then 3 monthly for one year. 

84 patients underwent the procedure. 31 patients had 2 line improvement in BCVA on snellens chart, 43 patient had one line improvement, 8 patients had minimal improvement, 2 had deterioration secondary to corneal haze after surgery that persisted for one year. 28 patients had subjective improvement of 2.0 diopters spherical equivalent, 37 patients had 1.0 diopters spherical equivalent improvement, 17 patients had nil or minor improvement in refractive error, 2 patients had deterioration secondary to corneal haze. these results were obtained at one month after the surgery. All results showed either maintainance of gains in vision or improvement with no deterioration. patients with haze improved over time but their vision remained subnormal.

combined limited topo guided corneal ablation with simultaneous collagen cross linking scores much better in terms of improvements in not only best corrected visual acuity but also refractive correction over collagen cross linking alone, thus has potential to improve patients quality of life