Zagreb Protocol - A Combined Guided T-Prk And Cxl Protocol For Treatment Of Low Visual Acuity Keartoconus

We wish to present the case series of 48 eyes that were treated with a combined CXL + Wavefront PRK protocol. The protocol functions by focusing on just the anterior elevation maps. Unlike previous presented protocols this one only focuses on reducing the total interior elevation differences between. The most extreme points. The goal of the protocol is to provide the best possible vision with the simplest possible optical device - glasses or soft contact lenses. 

University eye clinic Svjetlost, Zagreb

48 eyes of patients with keratoconus grading from 1 to 4 were treated. Inclusion criteria was CDVA less than 100% and patient reported shadows with glasses or soft contact lenses. Patients were screened using Pentacam, MS39, Corvis ST, Osiris-T and standard tools for refraction. For each patient, a custom ablation was planned on the Schwind CAM software considering the variability of the epithelium. All procedures were performed in the same day, custom laser ablation immediately following CXL on the Glaukos KXL machine. Ablations were limited to 15% of corneal tissues, excluding epithelium, and for sub 400-micron corneas, the Hafezi sub400 protocol was used. 

Average UCVA before the procedure was 0.77 logMAR (SD 0.47), average BCVA before the procedure was 0.22 logMAR (SD 0.22) with average BCVA after the procedure being 0.09 logMAR (SD 0.12), average corneal HoA before was 2.07 RMS while after HoA was 1.35. Coma decreased significantly in subjects before the procedure it was 1.6 RMS, while after the procedure the average coma was 0.89 RMS. 

Mean follow up was 1 year. 

Combined use of a novel wavefront guided ablation and modified CXL can be used to rehabilitate visual acuity and restore quality of life in patients using simple optical devices in lieu of complex devices like RGP or scleral lenses.