The Tel-Aviv Protocol For Post-Refractive Surgery Corneal Ectasia
Published 2023 - 41st Congress of the ESCRS
Reference: PP09.07 | Type: Free paper | DOI: 10.82333/c0cr-vz65
Authors: Dua Masarwa* 1 , Keren Blockstein 1 , Tzahi Sela 2 , Gur Munzer 2 , Igor Kaiserman 3
1Opthalmology,Barzilai Medical Center,Ashkelon,Israel, 2Opthalmology,Care-Vision Laser Center,Tel Aviv,Israel, 3Opthalmology,Barzilai Medical Center,Ashkelon,Israel;Opthalmology,Care-Vision Laser Center,Tel Aviv,Israel
Purpose
To describe the safety and efficacy of Tel-Aviv Protocol (epithelial photorefractive keratectomy (ePRK) and corneal cross-linking (CXL)) as a treatment for post-refractive surgery corneal ectasia.
Setting
Care-Vision Laser Centers, Tel-Aviv, Israel
Methods
8 eyes of 7 patients who presented several years after refractive surgery with decreased visual acuity and inferior corneal steepening were included. They were diagnosed with post-refractive surgery ectasia and treated with the Tel-Aviv Protocol. The procedure included: trans-epithelial PRK using the EX500 excimer laser, A 50-μm laser ablation of the epithelium, and the anterior stroma, delivered on the visual axis with cyclotorsion correction, treating up to 50% of refractive astigmatism. After the ePRK, all patients underwent CXL.
Results
The mean keratectomy and maximal K both decreased (from 43.37 ± 2.23 to 41.84 ± 2.01 ( P = 0.03), and from 44.95 ± 3.08 to 42.78 ± 2.19 (p=0.03); respectively). Astigmatism was significantly reduced (from -3.53 ± 2.36 to -0.88 ± 0.89 D; P= 0.02). UCVA improved significantly in all patients from 0.56 ± 0.32 to 0.15 ± 0.14 logMAR (P = 0.01). BCVA improved from 0.22 ± 0.24 to 0.06 ± 0.06 logMAR (P = 0.07; one tail P=0.04). All patients maintained visual acuity during the follow-up, up to 25 months, mean = 329 days. Tel-Aviv protocol was found to be safe (mean safety index: 1.63 ± 1.03 (range: 1.00 to 4)) and effective (mean efficacy index was 1.29 ± 0.66 (range: 0.71 to 2.1)).
Conclusions
Tel-Aviv Protocol, developed initially for keratoconus treatment, is a safe and promising procedure to stop post-refractive surgery ectasia progression while significantly improving vision, thereby avoiding keratoplasty.