PurposeA preliminary study to evaluate the outcomes of high-resolution wavefront-guided (HRWG) photorefractive keratectomy (PRK) with simultaneous corneal cross-linking (CXL) in ectasia eyes.MethodsSixteen eyes of 11 patients (mean age 31.9±9.8 years; range: 15–48 years) with keratoconus or post-laser-assisted in situ keratomileusis ectasia underwent HRWG PRK with simultaneous CXL. Manifest refraction, uncorrected (UDVA) and corrected distance visual acuity (CDVA), and keratometric and aberrometric outcomes are reported at 12 months.ResultsSignificant improvement was observed postoperatively in visual acuity, refraction, and keratectomy in all eyes. At postoperative 12 months, 87.5% eyes were within ±1.0 D of attempted correction and 81.25% of eyes had a postoperative UDVA of 20/32 or better. A gain of 2 or more lines of CDVA was observed in 12.5% (2/16) of eyes and there was no change in CDVA lines in 25% (4/16) eyes. A substantial reduction in higher-order aberrations was observed in all eyes postoperatively; however, the improvement was not statistically significant.ConclusionThe outcomes of HRWG PRK in ectasia eyes with estimated residual stromal bed thickness of at least 350 μm (without epithelium) are promising at postoperative 1 year and provide surgeons with a valuable tool to improve vision with a high degree of refractive predictability.
Purpose: To evaluate the visual and refractive outcomes after high-resolution wavefrontguided (HRWG) surface ablation with corneal crosslinking (CXL) in keratoconus eyes. Patients and Methods: In this prospective, interventional case series, 47 eyes of 28 progressive keratoconus patients older than age 18 were enrolled. All patients underwent HRWG photorefractive keratectomy (PRK) with simultaneous accelerated CXL. The study parameters were manifest refraction spherical equivalent (MRSE), keratometric outcomes, uncorrected (UDVA) and corrected distance visual acuity (CDVA) at postoperative 6 and 12 months. Results: There was improvement in mean MRSE from −2.39±1.89 D preoperatively to −0.13 ± 0.68 D at 12 months, with corresponding improvement in UDVA from 0.77 ± 0.35 logMAR to 0.08 ± 0.12 logMAR and CDVA from 0.10 ± 0.11 logMAR to 0.02 ± 0.04 logMAR. Preoperative flat and steep keratometry (K) were 4wct 32.49 ± 1.67 D and 45.94 ± 2.10 D, respectively, and at postoperative 12 months were 41.36 ± 2.08 D and 42.65 ± 2.78 D, respectively. At postoperative 12 months, visual and refractive outcomes were maintained. Comparisons between preoperative and postoperative 12 month timepoints were statistically significant for all parameters. Conclusion: Simultaneous wavefront-guided PRK followed by CXL is a promising treatment for the visual rehabilitation of keratoconus patients.
Keratoconus is a very frequent disease and is no diagnosed in many cases. Our chapter will focus on the several diagnostic tools not to miss this disease and also will present a all the treatment options with special focus on Corneal Cross Linking. All the indications for this treatment will be analyzed and extensively discussed as it should be considered the only option to stop the progress of the cone. Also, statistical analysis from our clinic with more than 2000 treatments with Cross Linking and follow up since 2006 will be presented. Literature review with results of this treatment is also going to be presented. Finally, a case of keratoconus treated with PRK and follow up of 30 years will be discussed and analyzed as the introduction of the combination of Cross Linking and Wavefront as one very good option in cases of mild to moderate keratoconus.
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