Combined t-PTK and A-CXL appears to be a safe and effective treatment for progressive keratoconus in the African cohort. The protocol provides both biomechanical stabilization and surface regularization, leading to functional visual improvement.TPTK-ACXL is particularly beneficial for African patients , who have thinner corneas and keratoconus often presents at advanced stages. Longer follow-up and larger multicenter studies are recommended to confirm long-term stability.
Efficacy And Safety Of Combined Transepithelial Phototherapeutic Keratectomy (T-Ptk) And Accelerated Corneal Collagen Cross-Linking In Progressive Keratoconus In An African Population
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR331 | Type: Free paper | DOI: 10.82333/hkkk-x066
Authors: Dr Priyanka Vijay Bhuyar* 1 , abhijit rasal 1 , shikha yadav 2
1ophthalmology,lions sight first eye hospital,nairobi,Kenya, 2ophthalmology,eye Sparsh hospital nagpur,nagpur,India
Purpose
Keratoconus frequently presents in more advanced stages in African populations, often with rapid progression and significant visual impairment. Combined transepithelial phototherapeutic keratectomy (T-PTK) with accelerated CXL offers the dual benefit of corneal surface regularization and biomechanical stabilization.However, data regarding the efficacy and safety of this combined approach in African patients are few.This study evaluates the efficacy and safety of combined transepithelial phototherapeutic keratectomy (t-PTK) and accelerated corneal collagen cross-linking (A-CXL) which is modified Cretan protocol ,in patients with progressive keratoconus in African population.
Setting
This study was conducted at Lions SightFirst Eye Hospital, a tertiary ophthalmic referral center in Nairobi, Kenya. All procedures were performed by a single experienced corneal surgeon to ensure surgical consistency and standardized treatment protocols.
Methods
This prospective study includes 24 eyes of 18 patients with documented progressive keratoconus. Exclusion criteria :Thinnest corneal thickness(TCT) <400 μm,active ocular infection or inflammation,previous ocular surgery,pregnancy or breastfeeding.Preoperative and postoperative assessments included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, maximum keratometry (Kmax), mean keratometry (Kmean),pachymetry,corneal topographic indices,corneal epithelial mapping,central ablation depth was recorded.t-PTK ablation using an excimer laser system was performed in a 7.0–9.0mm zone at an intended depth of 50–60 mm followed by A-CXL.Follow-up evaluations were performed at 1,3,6 and 12 months.
Results
At 12 months, significant improvement was observed in UDVA and CDVA (p < 0.05). BCVA was increased more than three lines in 24% patients. Mean corneal astigmatism improved from −5.34±3.40 diopters (D) preoperatively to −3.91±2.60 D (P = 0.015) at one year follow up.Kmax demonstrated significant flattening(p<0.001) with stabilization of keratometric progression in all treated eyes. Postoperative values of the irregularity index (IS), index of surface variance (ISV), index of vertical asymmetry (IVA), and index of height decentration (IHD) were significantly lower. Mild transient stromal haze was observed in 12% patients and resolved with topical therapy.No intraoperative or postoperative complications were observed in any of the patients.
Conclusions