ESCRS - PP14.15 - Five Year Outcomes Of A Novel Laser-Based Crosslinking Protocol To Treat Thin Corneas With Keratoconus

Five Year Outcomes Of A Novel Laser-Based Crosslinking Protocol To Treat Thin Corneas With Keratoconus

Published 2023 - 41st Congress of the ESCRS

Reference: PP14.15 | Type: Free paper | DOI: 10.82333/sxzr-pj02

Authors: Ritica Mukherji* 1 , Rohit Shetty 2 , Pooja Khamar 1 , Abhijit Sinha Roy 3

1Cataract and Refractive Services,Narayana Nethralaya,Bengaluru,India, 2Cornea and Refractive Services,Narayana Nethralaya,Bengaluru,India, 3GROW Labs,Narayana Nethralaya,Bengaluru,India

Purpose

To analyse the long-term safety & efficacy of a novel laser-based crosslinking protocol- Topography-guided Removal of Epithelium (TREK), designed to treat keratoconus patients with thinner corneas not amenable to traditional cross-linking procedures.

Setting

Narayana Nethralaya Super-speciality Eye Hospital, Bengaluru, India

Methods

A prospective interventional study was conducted after approval by the ethics committee. 100 eyes with Grade 2-3 keratoconus and a minimum corneal thickness of <420µm but greater than 400µm, were recruited for this study. All patients underwent Topography-guided Removal of Epithelium (TREK) followed by accelerated corneal collagen cross-linking on Schwind Amaris laser platform. Post-operative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), corneal topography and aberration profile were analysed at 5 years after the surgery. Collagen orientation was also assessed pre- and post-operatively by Polarisation-Sensitive Optical Coherence Tomography (PS-OCT).

Results

At 5 years post-operatively, there was a significant improvement in the UCVA (0.73±0.32 to 0.59± 0.33 log MAR, p=0.0006) and BCVA (0.18±0.13 to 0.12±0.12 log MAR, p=0.0034). There was a significant decrease in mean keratometry values from 49.64±0.45D to 47.63±0.46D (p<0.001). The decrease in the LOA and HOA were statistically significant (p<0.001). The PSOCT maps showed strengthening of collagen fibrils post-operatively. 

Conclusions

TREK is a safe technique for regularizing the anterior corneal surface with significant visual improvement. TREK showed similar magnitude of flattening while conserving greater amounts of tissue and may be an effective alternative to topo-guided PRK with CXL in the long term for thinner keratoconic eyes.