Official ESCRS | European Society of Cataract & Refractive Surgeons

Confocal microscopy findings in sequential intrastromal corneal ring segments implantation, collagen cross-linking and toporgaphy-guided PRK in keratoconus patients

Session Details

Session Title: Refractive
Session Date/Time: Sunday 22/02/2015 | 08:30-11:00
Paper Time: 09:36
Venue: Sadirvan A
First Author: : E.Branchevskaya RUSSIA
Co Author(s): :    A. Doga   Y. Kishkin   I. Svetlana        

Abstract Details


To describe morphological characteristics of cornea in patients underwent sequential Intrastromal Corneal Ring Segments (ICRS) implantation, collagen cross-linking CXL and PRK and to correlate localization of subepithelial haze and ablation profile.


S. Fyodorov Eye Microsurgery Federal State Institution.


Prospective, non-comparative analysis of 39 cases. 39 eyes of 34 keratoconus patients received manual ICRS implantation. Standard CXL procedure was performed 6 months after ICRS implantation. PRK without mitomycin C was performed at least 12 (12-36) months after CXL. Inclusion criteria for PRK procedure were stable refraction at least 6 months before PRK, corneal thickness at thinnest point 450μm or more. Transepithelial topograpy-guided PRK was performed using MicroScan Visum exсimer laser (Optosystems, Russia). Postoperative assessments included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), scheimpflug-tomography (Pentacam, Oculus, Germany) and confocal microscopy (CM) (Confoscan-4, Nidek, Japan).


Six months after PRK UDVA improved from 0.12±0.04 to 0.47±0.16 and CDVA from 0.47±0.12 to 0.65±0.13. No eyes lost lines of CDVA. 4 cases of haze grade 0.5 at the periphery of ablation zone were registered by slit lamp photography. CM findings 12 months after CXL included acellular zone 42% of eyes and spindle-shape bodies at 49% of eyes. 3 months after PRK in superficial stroma were found multiple hyperreflective keratocytes nuclei, which decreased by 6-12 months post.op. Regeneration of superficial nerve were found 9-12 months after PRK.


Topography-guided PRK performed 12-36 months after CXL is effective for improving visual acuity in select patients. Our study showed trace corneal haze at the periphery of ablation zone localized at the flat cornea area where “crescent-shaped” ablation was performed and no lost lines of CDVA. Previous confocal reports demonstrated existence of acellular zone up to 4 years after simultaneous PRK plus mitomycin C and CXL. Our study adds information about incomplete keratocyte repopulation at 12 months after CXL alone.

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