Original ArticleTopography-Guided Surface Ablation for Forme Fruste Keratoconus
Section snippets
Study Group
Eight patients asking for laser correction in the Institut für Refraktive und Ophthalmochirurgie (IROC) and at the University Hospital Zurich were enrolled in this pilot study. The age of the patients ranged from 28–54 years (average, 40.3±10 years). The refractive and demographic data are listed in Table 1. In 4 patients, a forme fruste keratoconus was diagnosed in both eyes and in 4 patients only 1 eye was affected. One patient had previously had LASIK in the other eye and developed an
Results
All surgeries were uneventful and the bandage lens could be removed on postoperative day 4. None of the patients demonstrated more than trace corneal haze at any time after surgery.
The refractive and visual data at the last follow-up are listed in Table 2. None of the eyes lost any line in BSCVA; however, 7 eyes (63%) gained ≥ 1 line. The refractive error was significantly reduced, spherical equivalent by −2.8±0.62 diopters (P = 0.0007) and cylinder by 1.34±0.18 diopters (P = 0.015). Ghosting
Discussion
Two major aspects must be considered regarding any surgical approach of keratectasia disorders of the cornea: (1) visual rehabilitation and (2) weakening of the already reduced biomechanical strength of the cornea.
In this study, we did not address the second point because we relied on earlier reports on a stable cornea in keratoconus after PRK3, 4; we also speculated that a residual stromal thickness of 450 microns might be enough to support the biomechanical stability of the cornea even in
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Cited by (59)
Efficacy comparison of combining cross-linking and refractive laser ablation in progressive keratoconus: systematic review and meta-analysis
2024, Canadian Journal of OphthalmologyTransepithelial photorefractive intrastromal corneal crosslinking versus photorefractive keratectomy in low myopia
2019, Journal of Cataract and Refractive SurgeryCitation Excerpt :For example, a study11 found that PRK was safe and effective for keratoconus-suspect corneas over a 5-year follow-up. Another study12 found that topography-guided laser ablation treatment improved the UDVA and CDVA in patients with mild to moderate degrees of keratoconus. However, in clinical practice, excimer laser keratectomy is still considered to be contraindicated in eyes with an unstable thin cornea with keratectasia.
Updates on Managements for Keratoconus
2018, Journal of Current OphthalmologyUpdates on corneal collagen cross-linking: Indications, techniques and clinical outcomes
2017, Journal of Current OphthalmologyMyopic Surface Ablation in Asymmetrical Topographies: Refractive Results and Theoretical Corneal Elastic Response
2017, American Journal of OphthalmologyLong-Term Comparison of Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Cross-linking versus Corneal Cross-linking Alone
2016, OphthalmologyCitation Excerpt :The results of this study demonstrate beneficial outcomes of the combined procedure in comparison with CXL alone. The application of excimer laser surface ablation has been introduced formerly for the correction of stable or forme fruste keratoconus,7–9 despite being a tissue-removing procedure. Alpins and Stamatelatos7 reported a prospective case series of 32 eyes treated with customized photoastigmatic refractive keratectomy and followed up for up to 10 years with no evidence of keratoconic progression.
Manuscript no. 2005-29.
- 1
Dr Seiler is a scientific consultant to and C. Donitzky is an employee of Wavelight Laser Technologie.
- 2
Drs Koller, Iseli, and Papadopoulos have no financial interest in this matter.