ESCRS - PP23.12 - Long-Term Results Of Combined Topography-Guided Photorefractive Keratectomy With Accelerated Collagen Cross-Linking

Long-Term Results Of Combined Topography-Guided Photorefractive Keratectomy With Accelerated Collagen Cross-Linking

Published 2024 - 42nd Congress of the ESCRS

Reference: PP23.12 | Type: Free paper | DOI: 10.82333/4mdn-1y77

Authors: Margarida Dias* 1 , Nuno Gouveia 1 , Pedro Gil 2 , João Quadrado Gil 1 , Andreia Rosa 3 , Maria João Quadrado 4 , Joaquim Murta 5

1Ophthalmology,Unidade Local de Saúde de Coimbra - Pólo HUC,Coimbra,Portugal;Clinical and Academic Centre Coimbra ,Coimbra,Portugal, 2Ophthalmology,Centro Hospitalar Universitário de Lisboa Central,Lisboa,Portugal;Ophthalmology,Unidade Local de Saúde de Coimbra - Pólo HUC,Coimbra,Portugal, 3Ophthalmology,Unidade Local de Saúde de Coimbra - Pólo HUC,Coimbra,Portugal;Clinical and Academic Centre Coimbra ,Coimbra,Portugal;Ophthalmology,Faculdade de Medicina de Coimbra,Coimbra,Portugal, 4Ophthalmology,Unidade Local de Saúde de Coimbra - Pólo HUC,Coimbra,Portugal;Ophthalmology,Clinical and Academic Centre Coimbra ,Coimbra,Portugal;Ophthalmology,Faculdade de Medicina de Coimbra,Coimbra,Portugal, 5Ophthalmology,Unidade Local de Saúde de Coimbra - Pólo HUC,Coimbra,Portugal;Ophthalmology,Faculdade de Medicina de Coimbra,Coimbra,Portugal;Clinical and Academic Centre Coimbra ,Coimbra,Portugal

Purpose

In managing keratoconus, a comprehensive approach is preferred, aiming to halt its progression and improve visual function. The combination of simultaneous topography-guided photorefractive keratectomy (TG-PRK) with acceleratedcollagen cross-linking (CXL) was developed to stabilize the disease and optimize corneal shape for better vision, given the limitations in visual improvement of the classical CXL protocols.

The goal of this study is to present our experience with combined TG-PRK and CXL in patients with keratoconus, while presenting the long-term tomographic and visual outcomes of patients submitted to this procedure.

Setting

This study was conducted at the Department of Ophthalmology in Coimbra Hospital and University Center (CHUC), Coimbra, Portugal and at the Clinical Academic Center of Coimbra (CACC) in Coimbra, Portugal.

Methods

Retrospective longitudinal case series of patients with keratoconus who underwent simultaneous TG-PRK and between January 2020 and December 2022. The follow-up ranged from 12 months to 3 years.

Results

We included 101 eyes of 93 patients. Mean age was 28.3(±8.9) years. Median BCVA was 0.5 (0.3-0.7) logMAR, mean spherical equivalent was -3.8(±3.3) D. At 1st year of follow-up, BCVA improved to 0.2(0.1-0.4) logMAR (p<0.005), which was maintained through follow-up.

After 1 year, mean Kmax improved from 58.6(±5.4) to 54.3(±5.4) D and was identical at the end of 3th year of follow-up. Regarding staging, the median A parameter of the Belin-Ambrosio classification decreased from 3.1(2.5-4.6) to 2.4(1.7-2.9) (p<0.005) after 1 year, slightly increasing to 2.5(2.0-2.8) after 3 years. In contrast, median B showed a significant increase (p<0.005). Corneal thickness decreased after the procedure, but was stable through the remaining follow-up.

 

Conclusions

At 1-year follow-up, 71 % of patients presented a gain of at least 1 Snellen line of BCVA and at 3 years the gain was 0.3 logMAR.

All eyes demonstrated corneal stability throughout the follow-up.

These findings show that combined TG-PRK and CXL is a safe and effective option that leads to corneal regularization and significant visual improvement in patients with keratoconus, without compromising corneal stability for up to 3 years postoperatively.