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Combined transepithelial phototherapeutic keratectomy and collagen cross linking using hypoosmolar riboflavin solution in progressive keratoconus management

Poster Details

First Author: M.Belovari Visnjic CROATIA

Co Author(s):    I. Knezovic   H. Raguz           

Abstract Details


To report a case of 40 year old male with progressive bilateral keratoconus who underwent transepithelial phototherapeutic keratectomy (TE-PTK) and corneal collagen cross linking (CXL) using hypoosmolar riboflavin solution in the same day procedure.


Knezovic Vision Group, 10000 Zagreb, Croatia


Eye examination showed: UCDVA on both eyes was between 0,01 and 0,02 according to Snellen charts, slit lamp biomicroscopy showed paracentral diffuse intrastromal corneal haze. Anterior OCT marked stromal hyperreflective zones and localized paracentral thinning of the cornea with conic shape. Sheimpflug tomography noted keratoconus stage IV on both eyes, according to Krumeich classification and CCT 278/ 296 microns at the thinnest location. After 40 microns TE-PTK, a CXL (3 mW/cm²) was performed for 30 minutes using hypoosmolar riboflavin solution. Left eye was treated first, and right eye 1 month after. Follow up period was 10 months.


One month after the treatment both eyes showed improvement in corneal topography (curvature and anterior elevation maps) and UCDVA was slightly better. Four months after the treatment UCDVA has improved to 0,1 and BSCVA has improved to 0,2-0,3 on both eyes.Eight months after the treatment special designed, atraumatic contact lenses for keratoconus (Rose K) were fitted, improving visual acuity to 0,6 on both eyes. Epithelial component of corneal decompensation (bullae) was absent and measures of the corneal shape showed more regular values.


Transepithelial phototherapeutic keratectomy and corneal collagen cross linking using hypotonic riboflavin solution as a same day procedure has shown to be a safe and promising method in this case of progressive keratoconus. It was necessary to consider certain parameters that could influence to safety and final outcome of this combined protocol.

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