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Customized laser stroma ablation combined with corneal cross-linking in patients with keratoconus

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First Author: D.Abelski BELARUS

Co Author(s):    E. Toropilova   I. Zabarouski   A. Haddad   L. Stolyarova           

Abstract Details

Purpose:

To evaluate the efficiency and safety of available customized ablation approaches (based on epithelial irregularity, wavefront-guided, topography-guided) combined with corneal crosslinking (CXL) in patients with moderate keratoconus (KC).

Setting:

Republican Ophthalmic Center, Voka Microsurgery Clinic, Minsk, Belarus

Methods:

We observed 30 patients (40 eyes) with stage I-II keratoconus (Amsler-Krumeich) for 12 month: after standard Dresden protocol CXL (DCXL) – 10 eyes, combined CXL + 50 µm phototherapeutic keratectomy (Cretan protocol) – 10 eyes, CXL + wavefront-guided ablation (iDesign + STAR S4IR, J&J Vision) - 10 eyes (WGA+CXL), topography-guided ablation (OCU-G treatment, WaveLight Refractive Suite, Alcon) – 10 eyes (TGA+CXL). CXL Dresden protocol was performed using UV-X1000 (IROC) and MedioCROSS D riboflavin solution (Avedro). Patient's examination included uncorrected and corrected distance visual acuity (UDVA and CDVA), keratometric indices, total (iDesign, J&J Vision) and corneal (TMS-5, Tomey) higher-order aberrations (HOA).

Results:

Cretan protocol, WGA+CXL and TGA+CXL groups showed significantly better results in improving UDVA and CDVA in 12 month observation compared to DCXL group (decimal UDVA of 0.14/0.12/0.16 improvement vs 0.08; decimal CDVA of 0.18/0.22/0.24 improvement vs 0,1), as well as average (Kav) and maximum (Kmax) axial map corneal indices (Kmax decrease of 1.7/1.9/3.2 vs 1.1 D; Kav decrease of 0.9/1.1/1.5 vs 0.8 D). TGA+CXL group showed significantly better results among all other groups in improving UCDA and CDVA (p<0,03), Kmax and Kav indices (p<0,01), total and corneal HOA (p<0,01). No cases of abnormal postoperative course or corneal decompensation were observed.

Conclusions:

Combined use of CXL and excimer laser customized ablation approaches seem to be safe and effective option to improve outcomes of keratoconus CXL treatment. The benefit of customized treatment’s is in the ability to decrease the severity of irregular astigmatism caused by ectasia. Being calculated on the corneal surface irregularity data which induces to majority of HOA’s in keratoconic eyes topography-guided treatment combined with CXL provides better outcomes in UCDVA, CDVA, Kmax and Kav, corneal and total HOA’s compared to Cretan protocol based on epithelial thickness variability and wavefront-guided treatment calculated on total eye aberrations data.

Financial Disclosure:

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