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Vienna 2018 Delegate Registration Programme Exhibition Virtual Exhibition Satellites 2018 Survey


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Topo-guided removal of epithelium in keratoconus (TREK) combined with cross-linking: a true personalised treatment protocol

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Session Details

Session Title: Primary and Secondary Ectasia

Session Date/Time: Sunday 23/09/2018 | 08:00-10:00

Paper Time: 09:18

Venue: Room A4

First Author: : S.Mahuvakar INDIA

Co Author(s): :    V. LG   R. Shetty   P. Khamar   A. Sinha Roy           

Abstract Details


To assess the visual, topographic and aberrometric outcomes of a novel tissue saving customised surgical approach for keratoconus (KC) combined with cross linking (CXL).


Narayan Nethralaya, Bangalore


Epithelial thickness was measured in 47 KC eyes using optical coherence tomography (Optovue, f/remont, CA). A customised elliptical ablation pattern was planned, which was centered at the location of the steepest point on the anterior tangential curvature map. PTK-CAM module of the Schwind-Sirius topographer was used. Stromal ablation did not exceed 25 u. This was followed by manual removal of surrounding epithelium over central 8 mm area and accelerated CXL (0.1% riboflavin for 20 mins and UV-A irradiation of 9mW/cm2 for 10 mins). Eyes were evaluated for visual acuity, keratometric and aberrometric outcomes up to 6 months after surgery.


Mean major and minor radius of ablation zone were 3.56and 3.11 mm, respectively. Mean distance of center of ablation zone was 0.88 +/- 0.35 mm. Uncorrected and corrected distant vision at 6 months had mean improvement of 0.21 and 0.06 LogMar ( P<0.05). Post-operatively, there was significant reduction in mean K (2.418 +/- 1.211 D), defocus (3.65 +/- 2.27 u, 73.7% decrease), spherical aberration (0.690 +/- 0.396 u, 63% decrease),vertical coma (0.562 +/- 0.641u, 29% decrease) and RMS of higher order aberration(-0.618 +/- 0.53 u, 21.6% decrease). These decrease were greater than previous topo-guided PRK reports with greater tissue ablation.


TREK combined with CXL is a safe and effective procedure with "true" customization to the patient needs. It significantly minimized the amount of stromal ablationin KC patientswhile delivering superior outcomes than topo-guided PRK.

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