Customised topography-guided PTK and CXL following intrastromal ring segments in decentred cones

Session Details

Session Title: Keratoconus & Secondary Ectasia

Session Date/Time: Sunday 15/09/2019 | 08:00-10:00

Paper Time: 08:24

Venue: Free Paper Forum: Podium 2

First Author: : N.Balakrishnan INDIA

Co Author(s): :    R. Shetty   A. Sinha Roy   P. Khamar   V. Laalgudi                    

Abstract Details

Purpose:

To assess the visual, topographic and aberrometric outcomes of a novel tissue sparing technique Topo-guided Removal of Epithelium for Keratoconus (TREK) along with accelerated corneal cross-linking (KXL) done after Intra Stromal Corneal Ring Segments (Intacs) insertion.

Setting:

Narayana Nethralaya Super Speciality Eye Hospital Bangalore India

Methods:

This was a prospective, interventional study in a tertiary eye hospital in India. 48 eyes(45 patients) with all grades of keratoconus with clear central cornea were included. All eyes underwent femto-assisted Intacs insertion. After one month, Customized Topo guided removal of epithelium was done. TREK is a decentered Trans-phototherapeutic keratectomy with center and area of ablation at the location of the steepest tangential anterior curvature and area of the cone respectively. Total ablation(epithelium plus stroma) was limited to 70µm. Postoperative measurements were performed at 1month post Intacs, 1month post I-TREK/KXL and at the final visit between 7-12months post Intacs.

Results:

The mean UDVA & CDVA(logMAR) improved from 1.05±0.05& 0.31±0.03 pre-operatively to 0.52 ± 0.05 (p<0.001)& 0.20±0.02 (p=0.009) respectively. The Mean sphere, cylinder &MRSE decreased from -4.52±0.98,-4.81±0.25,-6.93±0.99 to -0.77±0.53 (p=0.029),-3.13±0.24 (p=0.002) & -2.34±0.53(p=0.021) respectively with a mean keratometric flattening of 5.06D(p<0.0001).RMS of LOA&HOA reduced from 17.16±1.08μm to 11.66±0.87μm(p<0.001)& 4.54±0.28μm to 3.24±0.25μm(p=0.006).Safety and efficacy index were 1.32&0.67 respectively. Only 2.08% of the eyes lost 1 Snellen line of CDVA.68% &27% of the eyes gained 2 Snellen lines or more of UDVA&CDVA respectively.

Conclusions:

Simultaneous TREK and KXL one month after Intacs surgery provided superior visual and topographic outcomes better than Intacs with CXL by ablating significantly lower volume of tissue compared to topo-guided ablation techniques.

Financial Disclosure:

None