Combined Corneal Wavefront-Guided Photorefractive Keratectomy And Accelerated Corneal Crosslinking For Visual And Refractive Improvement Of Keratoconus: Five Year Follow-Up.
Published 2024 - 42nd Congress of the ESCRS
Reference: PP23.11 | Type: Free paper | DOI: 10.82333/70jb-9v34
Authors: JESUS CABRAL-MACIAS* 1 , ENRIQUE O. GRAUE-HERNANDEZ 2 , ALEJANDRO NAVAS 2 , DENISSE PINKUS 2 , ARTURO RAMIREZ-MIRANDA 2 , ALEJANDRO LICHTINGER 2
1CAVAMA,TEPIC,Mexico;CORNEA,CONDE DE VALENCIANA,MEXICO CITY,Mexico, 2CORNEA,CONDE DE VALENCIANA,MEXICO CITY,Mexico
Purpose
To evaluate the long-term refractive, visual and aberrometric outcomes for simultaneous corneal wavefront guided -PRK in combination with accelerated-CXL in patients with mild keratoconus.
Setting
Cornea and Refractive Surgery Department. Instituto de Oftalmologia ¨Fundacion Conde de Valenciana¨, Mexico City.
Methods
This was a prospective, interventional, clinical study conducted over a 5 year-period. Institutional Review Board approval was obtained, according to the Declaration of Helsinki.
Inclusion criteria: minimum age 18 years old, grade I-II KC, minimum pachymetry of 400um, with no previous surgery or ocular conditions. Pre and postoperative evaluations consisted of complete ophthalmological examination. Outcome measures were UDVA, CDVA, manifest sphere, cylinder, MRSE, thinnest pachymetry, keratometric values, total wavefront error, HOAs (coma, trefoil and spherical aberration). Safety and efficacy index were determined. Paired t-test and ANOVA were used to compare the pre and postoperative values. Statistical significance was set at p<0.05.
Results
Thirty eyes from 16 subjects were included. Preoperative and final postoperative outcomes were: UDVA improved from 0.86 to 0.18 logMAR (p<0.001), CDVA 0.04 to 0.01 logMAR (p=0.02), manifest sphere -1.09 to -0.15 D (p<0.001), cylinder -2.72 to -1.5 D (p<0.001) and MRSE -2.45 to 0.93 D (p<0.001). According to keratometric results (D) , there was significant flattening as expected (p<0.001 ). All analyzed corneal aberrations showed improvement, except for coma (p=0.24) and spherical aberration (p=0.062), whereas total wavefront error showed the most significant change (p<0.001). Efficacy index was 3.75 and safety index was 1. Low-grade haze (Grade 1) occurred in 56% of the eyes but was not visually significant.
Conclusions
To our knowledge, this study is among the longest follow-ups worldwide regarding corneal WG-PRK plus a-CXL for treatment of mild KC.
This surgical option shows to be an effective, safe treatment for mild KC with excellent long-term stability of the disease as well as visual and refractive outcomes.