Non-topography–guided Photorefractive Keratectomy for the Correction of Residual Mild Refractive Errors After ICRS Implantation and CXL in Keratoconus

Abstract

At the 6-month follow-up, non-topography-guided PRK after ICRS implantation and CXL was found to be an effective and safe option for correcting residual refractive error and improving visual acuity in patients with moderate keratoconus.

Corneal Collagen Cross-Linking with and without Epithelial Removal: A Contralateral Study with 0.5% Hypotonic Riboflavin Solution

“…The procedure led to UDVA and CDVA improvement and a decrease of the steep Sim K from 50.37 D to 44.21 D, as well as reduction of corneal asymmetry and spherical aberration. Epithelial removal has also been attempted by use of excimer laser; either via lamellar phototherapeutic keratectomy (PTK) [24], topography guided [25], or noncustomized PRK [26]. In addition to gentle epithelial removal, all three options showed stabilizing CXL effect and certain visual improvements due to better corneal optics.…”

One-Year Clinical Outcomes of a Two-Step Surgical Management for Keratoconus—Topography-Guided Photorefractive Keratectomy/Cross-Linking After Intrastromal Corneal Ring Implantation

“…[20][21][22] The impact of CXL combined with TG-PRK in patients' selfreported quality of life has been reported previously using various validated tools. 9,12,23 Labiris et al, 13 in a controlled study, reported that CXL combined with TG-PRK offered an improved self-reported quality of life in patients after treatment, but the scores of the patients with keratoconus were significantly lower than those of the matched healthy controls. The authors concluded that the technique should be implemented as soon as possible for the treatment of keratoconus.…”

“…The Ocular Wavefront Analyser and the Corneal Wavefront Analyser are reliable and have been recommended for use in refractive surgery, even though the Hartmann-Shack device was favored. 28 Although studies [12][13][14][15][16][18][19][20][21]23,34,35 have shown similar significant improvements in most of the tested visual functions, they have been conducted on a different population sample and/or have not agreed on all findings, partly because of the variation in the surgical protocol, and data collection/analysis method or follow-up duration. Additionally, many of these studies have been performed on a few eyes 15,16,20,21,23 and have used a format which is different from that recommended 25,26 in presenting their graphic data, thus making it difficult to directly compare results between studies.…”

“…[6][7][8] CXL alone may prevent topographic and refractive progression but it leads to minimal improvement in the quality of vision of patients, and it induces flattening. 7,9 However, a combination of various techniques such as conductive keratoplasty, 10 photorefractive keratectomy (PRK), [11][12][13][14] intrastromal corneal ring (ISCR) implantation plus PRK, 15,16 non-topography-guided PRK after ISCR implantation, 17 and simultaneous wavefront-guided PRK 18 with CXL maximizes the results by providing an overall additive effect on visual acuity, keratometry, and stability of the condition. 11,15,16,[19][20][21][22][23] Same-day simultaneous topography-guided PRK and CXL was shown to be superior to sequential CXL with later PRK in the visual rehabilitation of progressing keratoconus.…”

Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality

“…A 3-stage procedure has been proposed to halt the ectatic process, improve the corneal shape and visual acuity, and minimize the residual refractive error. Five studies analysed the efficacy and safety of the triple procedure: corneal CXL, ICRS implantation, and PRK [ 123 – 132 ]. All of these studies reported significant improvement in visual acuity, refraction, and corneal shape.…”