To Evaluate The Outcomes Of Sequential Topography Guided Photorefractive Keratectomy (Tgprk) Followed By Transepithelial Corneal Crosslinking (Tecxl) For Treatment Of Progressive Keratoconus.
Published 2025 - 43rd Congress of the ESCRS
Reference: PO556 | Type: Free paper | DOI: 10.82333/cn87-r472
Authors: Francisco J. Castro* 1 , Javier Mendicute del Barrio 2 , Itziar Matrínez-Soroa 3 , Martin Puzo Bayod 1 , Luis Pablo Julvez 1 , Marta Ibarz 4 , Javier Garcia Bella 5 , Pavel Stodulka 6
1Ophthalmology. Unidad de cirugía facorefractiva (UFR),Hospital Universitario Miguel Servet,Zaragoza,Spain;GIMSO, Institute for Health Research,Zaragoza,Spain, 2Hospital Universitaria Donostia,San Sebastián,Spain;Miranza Begitek,Donostia-Sebastian,Spain, 3Hospital Universitaria Donostia,San Sebastián,Spain, 4Grupo Oftalvist,Alacant,Spain, 5Hospital Clínico San Carlos,Madrid,Spain, 6Gemini Eye Clinic,Zlin,Czech Republic;3rd Faculty of Medicine,Charles University,Prague,Czech Republic
Purpose
Simultaneous Topography Guided Photorefractive Keratectomy (TGPRK) with Corneal Cross linking (CXL) is one of the established treatment modalities for achieving the dual goals of improving visual quality as well as halting progression of ectasia in cases of progressive keratoconus (KCN). In this combined approach, CXL is necessarily an ‘epithelium off procedure’ with its attendant risks of delayed epithelial healing, corneal haze/deep stromal scarring and progressive flattening l .
The purpose of the current study was to evaluate at 3 months outcomes of a sequential approach involving TGPRK as the first step followed 4 weeks later by Accelerated Transepithelial Corneal Crosslinking (Acc TECXL) for progressive KCN.
Setting
Prospective, interventional study conducted at the Cornea Services of a tertiary care Ophthalmology institute in India.
Methods
Twelve eyes of 12 pateints with progressive stage 1-2 KCN, fulfilling the following criteria were included i) Age > 18 years ii) minimum corneal thickness (MCT) > 450µ iii) spectacle corrected distance visual acuity(CDVA) < 20/20 iv) contact lens intolerance. After alcohol assisted epithelial removal, TGPRK upto maximum ablation depth of 60 µ was performed on WaveLight Ex 500 excimer laser to treat corneal HOA’s, regularize the anterior cornea and partially correct refractive error. 4 weeks later all eyes underwent Acc TECXL (9mW/cm2 X 10 min of UVA). Outcome measures evaluated at 3 months were change in uncorrected distance visual acuity (UDVA), spectacle CDVA, measured cylinder, MCT and topography as compared to baseline.
Results
Mean age was 22.9 ± 3.3 years (19-29 yrs) with 8 males and 4 females. Mean LogMAR UDVA (0.35 ± 0.27) and spectacle CDVA (0.06 ± 0.08 ) at 3 months improved significantly compared to baseline UDVA (0.67 ±0.32)(p=0.007) and CDVA (0.28 ± 0.16)(p=0.001). Measured cylinder post treatment reduced significantly by 1.54 ± 1.54 D (p=0.005) while the reduction in MRSE (0.51 ± 2.23 D) was not significant (p=0.45). Mean MCT reduced by approximately 38 µ from 475± 18µ at baseline to 437 ± 20 µ at 3 months (p<0.001). Maximum keratometry decreased significantly by 2.69 ± 1.74 D (p<0.001) while mean keratometry (Km) remained comparable (p=0.15). Gain of 2 or more lines of UDVA and CDVA was noted in 8 (66.6%) and 5 (41.7%)eyes respectively.
Conclusions
TGPRK followed by accelerated TECXL was efficacious in stabilizing ectasia and improving UDVA and spectacle CDVA in a significant number of patients at 3 months, without the attendant risks of delayed healing and increased haze often reported with the simultaneous procedure. However a longer follow up is advisable to determine its efficacy and safety compared to the combined protocol