Long-Term Visual, Refractive, And Patient-Reported Satisfaction Of The Tel-Aviv Protocol (Eprk-Cxl) For Progressive Keratoconus
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR180 | Type: Free paper | DOI: 10.82333/qdj7-vp92
Authors: Dr Adir Sommer 1 , Dr Asaf Friehmann 2 , Prof. Michael Mimouni* 1 , Mr Tzahi Sela 3 , Gur Munzer 3 , A/Prof. Igor Kaiserman 4
1Rambam Health Care Campus,Haifa,Israel, 2Sheba Medical Center,Ramat Gan,Israel, 3Care-Vision Laser Center,Tel-Aviv,Israel, 4Barzilai Medical Center,Ashkelon,Israel
Purpose
To evaluate the long-term visual, refractive, and patient-reported satisfaction of epithelial photorefractive keratectomy (ePRK) combined with corneal cross-linking (CXL) - the Tel-Aviv Protocol - in patients with progressive keratoconus.
Setting
Retrospective case series, Care-Vision Laser Centers, Tel Aviv, Israel.
Methods
In this retrospective case series, consecutive patients with progressive keratoconus who underwent ePRK-CXL at Care-Vision Laser Centers, Tel Aviv, Israel were included. Data collected included thinnest corneal thickness, keratometric values (average K, K minimum, K maximum), spherical equivalent (SEQ), manifest sphere and cylinder, uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA). Safety and efficacy indices were calculated. Additionally, patient-reported satisfaction regarding spectacle/contact lens dependence, satisfaction, and visual symptoms were assessed using a questionnaire.
Results
The study included 50 eyes of 38 patients (mean age 25.9 years) with a mean follow-up of 2,910±605 days (~8 years, range 5–12 years). Results demonstrated significant improvements (P<0.001) in BCVA (0.62 to 0.80) and UCVA (0.21 to 0.54). Safety and efficacy indices were 1.42 and 0.93. Tomography showed significant reductions (P<0.001) in K-max (47.51 to 45.95 D) and SEQ (-2.42 to -0.74 D). Post-operative pachymetry decreased from 448.65 to 418.93 μm. Patient-reported outcomes indicated high satisfaction (81.6%) and subjective visual improvement (76.3%). Spectacle independence was achieved in 52.6%. Halos and glare were rare or absent in 68.4%, and night glare remained unchanged for 73.7%. No cases of progression occurred.
Conclusions
The Tel-Aviv Protocol (ePRK-CXL) demonstrates stable long-term visual and refractive outcomes at a mean follow-up of approximately 8 years in patients with progressive keratoconus, with significant improvement in both UCVA and BCVA, reduction in keratometric values and astigmatism, high patient satisfaction, and low symptom burden. These long-term results support the durability, safety, and efficacy of the Tel-Aviv Protocol as a management option for progressive keratoconus.