Two stage management of selected cases of keratoconus: clear lensectomy followed by combined corneal cross-linking with topo-guided photorefractive keratotomy
First Author: W.Ali Abousamra EGYPT
Co Author(s): T. Mokbel M. Elwan S. Saleh A. Wehidy M. Ikbal A. Ellayeh
To evaluate the visual and topographic outcomes of a two-stage approach treatment for selected cases of keratoconus (KC); Clear lensectomy with a spherical intraocular lens (IOL) implantation followed by combined Corneal Cross-linking (CXL) with Topo -guided Photorefractive Keratotomy (TG-PRK).
The study included 11 eyes of 17 patients diagnosed with stable keratoconus, aged from 39 to 49 years (42.4 ± 6.2). All studied eyes underwent a 2-stage approach treatment: first refractive lens exchange and IOL implantation followed after at least 3 months by combined CXL with TG-PRK. A complete ophthalmological examination was performed preoperatively and postoperatively. Topographical and visual outcomes were evaluated during 6 months follow up period.
After the 2 stages procedure, sphere changed from -10.33 ± 4.18 diopter preoperatively to 0.67 ± 0.71 diopter 6 months postoperatively (p<0.001), and cylinder changed from -4.21 ± 0.91D to -1.13 ± 0.69 D (p<0.001). There with significant improvement in the mean uncorrected distance visual acuity (UDVA) from log MAR 1.41 ± 0.49 preoperatively to 0.32 ± 0.08 postoperatively (p<0.001) and the mean corrected distance visual acuity (CDVA) from 0.55 ± 0.14 preoperatively to 0.26 ± 0.11 (p=0.01). All patients were satisfied with their visual improvement.
This 2-stage approach in selected cases of stable keratoconus with high refractive errors is safe, effective and highly predictable procedure with satisfactory visual and refractive results