for Keratoconus (KC) With Simultaneous Collagen Cross
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Transcript for Keratoconus (KC) With Simultaneous Collagen Cross
Topography-Guided Photorefractive
Keratectomy (TG-PRK) for Keratoconus (KC)
With Simultaneous Collagen Cross-Linking
(CXL): Excimer Laser
Simon Holland
David TC Lin
ASCRS, Chicago, Illinois 2012
*No financial interests
Purpose
To evaluate efficacy and safety of
simultaneous TG-PRK for KC with
simultaneous CXL
Methods
127 keratoconus eyes underwent treatment with Allegretto
excimer laser
Treatment targeted at -1.25 post-op, with minimal residual stromal
depth 300microns
Epithelial removal by trans-epithelial laser
Topography-guided PRK, T-CAT software, modified by TNT
(topographical neutralization)
Riboflavin 0.1% in dextran, until aqueous staining
UV irradiation with riboflavin (up to 20 minutes)
UV 370 um, 3mW/cm2 - 5.4 J/m2
Hypotonic dextran if <400 um
Bandage contact lens, standard post PRK
management
TG-PRK CXL for KERATOCONUS
Pre-op: +1.75-4.00x060
BSCVA: 20/30-
6 months post-op
UCVA: 20/30
RX: +0.25-0.75x170 20/25
TG-PRK CXL for KERATOCONUS
Pre-operative
6 months post-op
UCVA 20/60
UCVA: 20/40+
MR: +2.25-2.00X120 20/40- MR: -0.50-0.50X60 20/30-
TG CXL PRK for KERATOCONUS
Pre-op: -2.75-2.25x010 12 months post-op
BSCVA: 20/20UCVA: 20/30RX: +0.50-0.50x020
20/30-
Results
99 eyes completed 6 months follow-up
53 (54%) had ≥20/40 or better uncorrected visual acuity
(UVA)
92 (93%) had ≥20/40 or better best corrected visual acuity
(BCVA)
51 (52%) had BCVA improved, 32 (32%) improved BCVA 2
lines or more, 33 (33%) no change, 4 (4%) lost 2 lines or more
Mean astigmatism decreased -2.77D pre-op to
-1.14D
4 had delay in epithelial healing with subsequent haze, 2
developed haze sufficient to reduce BCVA more than 2 lines,
1 had herpetic keratitis – 3 recovered pre-operative BCVA.
Glare, halos, and difficulties with night driving decreased from
3.5 to 2.0 on a 4 point score (n=25)
Conclusions
Simultaneous TG-PRK with CXL using customized
TNT technique shows promise to improve both
UCVA and BCVA in keratoconus patients with
reasonable efficacy and safety
Longer term results are needed to establish value
and safety of combining attempted refractive
correction and topographical regularization with
collagen cross linking