Outcomes Of Transepithelial Topography-Guided Surface Ablation Combined With Corneal Cross-Linking Using A Myopic “Increment” Epithelial-Removal Approach On The Wavelight Platform: A Prospective Study

To evaluate visual, refractive, topographic, and pachymetric outcomes after transepithelial topography-guided surface ablation combined with corneal cross-linking (CXL) using a myopic “increment” method (epithelium-on) to remove the corneal epithelium and concurrently treat refractive error on the WaveLight platform in eyes with corneal ectatic disease.

Prospective study conducted at a private center in the Asir region. A total of 30 eyes from 22 patients were included. Mean age was 26.1 ± 5.9 years (range 19–38); 59.1% were male. Preoperative evaluation included corneal tomography and anterior segment OCT epithelial thickness mapping to document epithelial profile

Treatment was performed on the WaveLight platform using transepithelial topography-guided surface ablation with an “incremental myopia” epithelial-removal strategy (epithelium-on), in which stepwise myopic treatment was used to achieve epithelial removal while simultaneously delivering the planned refractive/topography-guided ablation. Planned refractive treatment (mean ± SD) included sphere −3.87 ± 1.8 D, cylinder −2.18 ± 0.87 D, and spherical equivalent −4.96 ± 1.92 D. Optical zones ranged from 5.0–7.0 mm. Accelerated CXL was performed in the same session. Outcomes were assessed at 1 week, 1,3,6, and 12 months postoperatively. Primary outcomes included UCVA/BCVA, manifest refraction, keratometry, topographic astigmatism, and pachymetry. 

UCVA improved from 0.75 ± 0.38 preoperatively to 0.33 ± 0.27 at 6 months (p=0.004). BCVA improved from 0.28 ± 0.20 to 0.11 ± 0.12 at 6 months (p=0.022). Spherical equivalent improved from −4.21 ± 3.49 D to −1.31 ± 1.79 D at 6 months (p=0.003). Significant flattening was observed: Kmax 47.19 ± 2.80 → 42.12 ± 2.11 D at 6 months (p<0.001). K1 and K2 also decreased significantly (both p<0.001). Topographic astigmatism showed significant change at follow-up (p≤0.024). Mean epithelial healing was typically 5 days (60%); most eyes had no healing problem (76.7%), with infrequent mild haze/persistent epithelial defect events. Twelve-month outcomes were available for only 3 eyes.

In this prospective series, transepithelial topography-guided surface ablation combined with CXL using a myopic “increment” epithelium-on epithelial-removal approach on the WaveLight platform demonstrated significant improvements in uncorrected and corrected vision, refractive error, and corneal topography with generally favorable outcomes. Longer follow-up and larger samples are needed to confirm long-term stability and safety.