To investigate the effects of combined corneal wavefront-guided transepithelial photorefractive keratectomy (tPRK) and accelerated corneal collagen cross-linking (CXL) after intracorneal ring segment (ICRS) implantation in patients with moderate keratoconus.
Medical records of 23 eyes of 23 patients undergoing combined tPRK and CXL after ICRS implantation were retrospectively analyzed. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), corneal indices based on Scheimpflug tomography, higher-order aberrations (HOAs), and corneal biomechanical properties were evaluated before and after ICRS implantation, and at 1, 3, and 6 months after combined tPRK and CXL.
There were significant improvements in final logMAR UDVA and logMAR CDVA, and reductions in sphere, MRSE, and all corneal indices from baseline. Significant improvements in logMAR UDVA and reductions in sphere, MRSE, maximal keratometry, keratometry at the apex, mean keratometry, and keratoconus index were noted after ICRS implantation. After tPRK and CXL, significant improvements in logMAR UDVA and logMAR CDVA, and reductions in cylinder and all corneal indices were observed. There were significant improvements in final root mean square HOAs and coma aberrations from baseline, but no changes from baseline after ICRS implantation. Significant reductions in final radius and deformation amplitude from baseline were noted.
Combined tPRK and accelerated CXL after ICRS implantation in moderate keratoconus appears to be a safe and effective treatment, providing an improvement in visual acuity, corneal indices, and HOAs.
retrospectively registered (identification no. NCT03355430). Date registered: 28/11/2017.
Elbaz U, Shen C, Lichtinger A, Zauberman NA, Goldich Y, Ziai S, Rootman DS. Accelerated versus standard corneal collagen crosslinking combined with same day phototherapeutic keratectomy and single intrastromal ring segment implantation for keratoconus. Br J Ophthalmol. 2015;99(2):155–9. CrossRefPubMed
Ng AL, Chan TC, Cheng AC. Conventional versus accelerated corneal collagen cross-linking in the treatment of keratoconus. Clinical & experimental ophthalmology. 2016;44(1):8–14. CrossRef
Lee H, Yong Kang DS, Ha BJ, Choi JY, Kim EK, Seo KY, Kim TI. Comparison of outcomes between combined Transepithelial photorefractive keratectomy with and without accelerated corneal collagen cross-linking: a 1-year study. Cornea. 2017;36(10):1213–20. PubMed
Lee H, Roberts CJ, Ambrosio R Jr, Elsheikh A, Kang DSY, Kim TI. Effect of accelerated corneal crosslinking combined with transepithelial photorefractive keratectomy on dynamic corneal response parameters and biomechanically corrected intraocular pressure measured with a dynamic Scheimpflug analyzer in healthy myopic patients. J Cataract Refract Surg. 2017;43(7):937–45. CrossRefPubMed
Tomita M, Yoshida Y, Yamamoto Y, Mita M, Waring Gt: In vivo confocal laser microscopy of morphologic changes after simultaneous LASIK and accelerated collagen crosslinking for myopia: one-year results . J Cataract Refract Surg 2014, 40(6):981-990.
Zeraid FM, Jawkhab AA, Al-Tuwairqi WS, Osuagwu UL. Visual rehabilitation in low-moderate keratoconus: intracorneal ring segment implantation followed by same-day topography-guided photorefractive keratectomy and collagen cross linking. International journal of ophthalmology. 2014;7(5):800–6. PubMedPubMedCentral
Ambrósio R Jr, Ramos I, Luz A, Faria FC, Steinmueller A, Krug M, Belin MW, Roberts CJ. Dynamic ultra high speed Scheimpflug imaging for assessing corneal biomechanical properties. Revista Brasileira de Oftalmologia. 2013;72:99–102. CrossRef
Roberts CJ, Mahmoud AM, Bons JP, Hossain A, Elsheikh A, Vinciguerra R, Vinciguerra P, Ambrosio R Jr. Introduction of two novel stiffness parameters and interpretation of air puff-induced biomechanical deformation parameters with a dynamic Scheimpflug analyzer. J Refract Surg. 2017;33(4):266–73. CrossRefPubMed
Hon Y, Lam AK. Corneal deformation measurement using Scheimpflug noncontact tonometry. Optometry and vision science : official publication of the American Academy of Optometry. 2013;90(1):e1–8. CrossRef
Alio JL, Pinero DP, Aleson A, Teus MA, Barraquer RI, Murta J, Maldonado MJ, Castro de Luna G, Gutierrez R, Villa C, et al. Keratoconus-integrated characterization considering anterior corneal aberrations, internal astigmatism, and corneal biomechanics. J Cataract Refract Surg. 2011;37(3):552–68. CrossRefPubMed
- Visual rehabilitation in moderate keratoconus: combined corneal wavefront-guided transepithelial photorefractive keratectomy and high-fluence accelerated corneal collagen cross-linking after intracorneal ring segment implantation
David Sung Yong Kang
Byoung Jin Ha
Jin Young Choi
Eung Kweon Kim
Kyoung Yul Seo
- BioMed Central