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Non-topoguided photorefractive keratectomy for the correction of residual mild refractive errors after intracorneal ring segments implantation and corneal collagen cross-linking in keratoconus

Session Details

Session Title: Refractive

Session Date/Time: Sunday 16/02/2014 | 08:30-11:00

Paper Time: 09:50

Venue: Kosovel Hall (Level -2)

First Author: : AliDirani LEBANON

Co Author(s): :    Ali Fadlallah   Elias Chelala   Zeba Syed   Ziad Khoueir   George Cherfan   Elias Jarade

Abstract Details

Purpose:

To evaluate the safety and clinical outcome of photorefractive Keratectomy (PRK) for the treatment of residual mild refractive errors 6 months after sequential Intracorneal Ring segments (ICRS) and corneal collagen UVA cross-linking (CXL) in stable keratoconus.

Setting:

Beirut Eye Specialist Hospital, beirut, lebanon

Methods:

A retrospective study examined the results of a 3-step (ICRS-CXL)/PRK in 17 eyes of 14 patients with mild to moderate keratoconus. The two procedures (ICRS-CXL) were performed sequentially at an interval of 4 weeks and PRK was performed at least 6 months after CXL. Data were collected preoperatively, at the 6-month follow-up visit after sequential ICRS-CXL, and at the 6-month follow-up visit after PRK.

Results:

ICRS-CXL induced a significant decrease in keratometry, increase in visual acuity and decrease in refraction. At 6-month follow-up after ICRS-CXL, mean Kflat was 44.33 ±2.29 D vs. 46.51 ±2.12 D preoperatively (p=0.01) and mean Ksteep was 47.41 ±2.91 D vs. 50.76 ±2.19 D preoperatively (p=0.01). Uncorrected distance visual acuity (UDVA) significantly improved from 1.17 ±0.38 logMAR before ICRS-CXL to 0.45 ±0.11 logMAR 6 months after (p = 0.001) and corrected distance visual acuity (CDVA) significantly improved from 0.44 ±0.09 logMAR to 0.17 ±0.08 logMAR (p=0.001). The mean spherical error decreased from -5.45 ±1.64 D to -2.57 ±1.15 D (p=0.01), and the mean cylinder from 3.86 ±1.15 D to 2.13 ±1.11 D (p=0.01). At 6-month post PRK, UDVA improved significantly to 0.18 ±0.06 logMAR and the CDVA was 0.15 ±0.05 logMAR. The safety and efficacy indices of PRK after ICRS-CXL were 1.06 and 0.97 respectively. The mean spherical error decreased significantly to -1.1 ±0.41 D (p=0.02), and the mean cylinder decreased significantly to 0.98 ±0.37 D (p=0.046). No intraoperative or postoperative complications occurred.

Conclusions:

Photorefractive keratectomy after sequential Intracorneal Ring Segments and corneal collagen cross-linking is an effective and safe option for correcting residual refractive error and improving visual acuity in patients with moderate keratoconus. FINANCIAL INTEREST: NONE