Enhanced Corneal Cross-Linking With Laser Epithelial Removal For Keratoconus Treatment

 Keratoconus is a progressive degenerative disease of the cornea, which leads to its thinning, deformation and a significant decrease in visual functions. Corneal crosslinking according to the Dresden protocol (CXL) is considered the "gold standard" in stabilizing the process. However, improving epithelial removal methods can improve the effectiveness of the procedure, reduce complications and shorten the rehabilitation period. 

To study the effectiveness of the treatment of keratoconus stages 2-3.

The results of surgical intervention were analyzed. Under the supervision of 50 patients (66 eyes) with diagnosed keratoconus of stages 2-3, who were divided into 2 groups. Who underwent classic epi-off CXL and CXL with laser removal of the epithelium. The first group consisted of 26 patients (34 eyes) who underwent classic epi-off CXL. Among them, 17 eyes (50%) had keratoconus of stage 2, and 17 eyes (50%) had keratoconus of stage 3. The second group included 24 patients (32 eyes) who underwent CXL with laser removal of the epithelium. Among them, 22 eyes (64%) had keratoconus of stage 2, and 10 eyes (36%) had keratoconus of stage 3. All patients underwent a standard ophthalmological examination. 

In Group 1, corneal thickness decreased from 453 ± 5 μm to 445 ± 5 μm (1.8%). Uncorrected visual acuity (UCVA) improved from 0.15 ± 0.05 to 0.20 ± 0.06, while best-corrected visual acuity (BCVA) increased from 0.20 ± 0.05 to 0.40 ± 0.07 (twofold). 

In Group 2, corneal thickness decreased from 462 ± 5 μm to 457 ± 5 μm (1.1%). UCVA improved from 0.20 ± 0.06 to 0.32 ± 0.08 (60% improvement), and BCVA increased from 0.25 ± 0.06 to 0.60 ± 0.10 (2.4-fold). Corneal thinning reduction was 1.8% in Group 1 versus 1.1% in Group 2. UCVA improvement reached 33% in Group 1 and 60% in Group 2 compared to baseline. BCVA doubled in Group 1 and increased 2.4-fold in Group 2, indicating a more pronounced visual gain in the laser-assisted group. 

Corneal Thickness. At 3 months post-op, Group 1 experienced a 1.8% reduction in corneal thickness, while Group 2 showed only a 1.1% reduction compared to pre-operative measurements. 

UCVA Improvement. Group 1 showed a 33% improvement in UCVA, whereas Group 2 demonstrated a 60% improvement.

BCVA Improvement. BCVA increased twofold in Group 1 and 2.4-fold in Group 2, indicating a more pronounced effect with the laser-assisted technique.