<p>High-Resolution Wavefront-Guided Photorefractive Keratectomy and Accelerated Corneal Crosslinking for Stabilization and Visual Rehabilitation of Keratoconus Eyes</p>

Abstract

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.

Advances in the Treatment of Keratoconus: Epithelial-On (EPI-On) Corneal-Collagen Cross-Linking (CXL) and CXL-Plus Procedures

“…Tamayo et al [ 19 ] conducted a pilot study examining at wavefront-guided PRK along with simultaneous ACXL in patients with KC. High-order aberrations do play an important role in reduced visual acuity.…”

“…At the end of their study, Tamayo et al reported insignificant improvements in HOA, including mean coma, spherical aberration, and total root mean square (RMS). These improvements, however, did lead to significant improvements in mean UDVA, mean CDVA, and keratometric readings [ 19 ]. Findings from Tamayo et al suggest that wavefront-guided interventions have the potential to target HOAs.…”

Management of keratoconus: an updated review

“…As CXL leads to gradual changes in the anterior corneal curvature for up to a year postoperatively, there is a valid question over the exact refraction target in combined procedures. Nonetheless, promising results are still observed in specific protocols without any adjustment for such refractive changes ( 229 ).…”

Keratoconus: A Treatable Disease

“…A very important paper from John Kanelopoulus [65], brought the term Athens Protocol to ophthalmology, that popularized this type of combined treatment soon after. Two papers have been published with our own results [66,67].…”