Stability of simultaneous topography-guided photorefractive keratectomy and riboflavin/UVA cross-linking for progressive keratoconus: Case reports

Ronald R. Krueger, A. John Kanellopoulos

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

PURPOSE: To follow the stability of a simultaneously delivered therapy that corrects aberrations and stiffens the corneal collagen of eyes with progressive keratoconus. METHODS: Two patients with progressive keratoconus underwent partial treatment (70% cylinder and sphere up to 50-μm central depth) with topographic customized photorefractive keratectomy (PRK) using the T-CAT module of the ALLEGRETTO WAVE Eye-Q excimer laser (Alcon Laboratories Inc), and then immediate corneal collagen cross-linking (CXL) with riboflavin 0.1% drops every 2 minutes while exposed to mean 365-nm ultraviolet A (UVA) light at 3.0 mW/cm2 for 30 minutes (the Athens Protocol). Pre- and postoperative evaluations included manifest and cycloplegic refraction, Scheimpflug corneal tomography and pachymetry, and slit-lamp examination of corneal clarity with a minimum follow-up of 30 months. RESULTS: Both treated eyes experienced rapid healing of the epithelial surface within 5 days and progressive improvement of vision. In the first case, partial treatment reduced the astigmatism and aberrations, allowing for successful soft contact lens wear at 3 months. Follow-up at 13, 19, 30, and 36 months showed progressive reduction of refractive myopia and keratometric power. In the second case, laser treatment led to a near emmetropic refraction with an uncorrected visual acuity of 20/20 at 3 months, which remained unchanged at 21 and 30 months postoperative. CONCLUSIONS: Partial topography-guided PRK followed by riboflavin/UVA CXL is a safe and effective therapy that halts the progression of keratoectasia and reduces the spherocylindrical refraction and aberrations to improve the visual function of patients with progressive keratoconus. Stability and progressive improvement over time is observed, although limitations may exist for steeper and thinner corneas.

Original languageEnglish (US)
Pages (from-to)S827-S832
JournalJournal of Refractive Surgery
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2010

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Photorefractive Keratectomy
Keratoconus
Riboflavin
Collagen
Corneal Pachymetry
Mydriatics
Hydrophilic Contact Lens
Therapeutics
Excimer Lasers
Astigmatism
Myopia
Ultraviolet Rays
Cornea
Visual Acuity
Lasers
Tomography

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology

Cite this

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title = "Stability of simultaneous topography-guided photorefractive keratectomy and riboflavin/UVA cross-linking for progressive keratoconus: Case reports",
abstract = "PURPOSE: To follow the stability of a simultaneously delivered therapy that corrects aberrations and stiffens the corneal collagen of eyes with progressive keratoconus. METHODS: Two patients with progressive keratoconus underwent partial treatment (70{\%} cylinder and sphere up to 50-μm central depth) with topographic customized photorefractive keratectomy (PRK) using the T-CAT module of the ALLEGRETTO WAVE Eye-Q excimer laser (Alcon Laboratories Inc), and then immediate corneal collagen cross-linking (CXL) with riboflavin 0.1{\%} drops every 2 minutes while exposed to mean 365-nm ultraviolet A (UVA) light at 3.0 mW/cm2 for 30 minutes (the Athens Protocol). Pre- and postoperative evaluations included manifest and cycloplegic refraction, Scheimpflug corneal tomography and pachymetry, and slit-lamp examination of corneal clarity with a minimum follow-up of 30 months. RESULTS: Both treated eyes experienced rapid healing of the epithelial surface within 5 days and progressive improvement of vision. In the first case, partial treatment reduced the astigmatism and aberrations, allowing for successful soft contact lens wear at 3 months. Follow-up at 13, 19, 30, and 36 months showed progressive reduction of refractive myopia and keratometric power. In the second case, laser treatment led to a near emmetropic refraction with an uncorrected visual acuity of 20/20 at 3 months, which remained unchanged at 21 and 30 months postoperative. CONCLUSIONS: Partial topography-guided PRK followed by riboflavin/UVA CXL is a safe and effective therapy that halts the progression of keratoectasia and reduces the spherocylindrical refraction and aberrations to improve the visual function of patients with progressive keratoconus. Stability and progressive improvement over time is observed, although limitations may exist for steeper and thinner corneas.",
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T1 - Stability of simultaneous topography-guided photorefractive keratectomy and riboflavin/UVA cross-linking for progressive keratoconus

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N2 - PURPOSE: To follow the stability of a simultaneously delivered therapy that corrects aberrations and stiffens the corneal collagen of eyes with progressive keratoconus. METHODS: Two patients with progressive keratoconus underwent partial treatment (70% cylinder and sphere up to 50-μm central depth) with topographic customized photorefractive keratectomy (PRK) using the T-CAT module of the ALLEGRETTO WAVE Eye-Q excimer laser (Alcon Laboratories Inc), and then immediate corneal collagen cross-linking (CXL) with riboflavin 0.1% drops every 2 minutes while exposed to mean 365-nm ultraviolet A (UVA) light at 3.0 mW/cm2 for 30 minutes (the Athens Protocol). Pre- and postoperative evaluations included manifest and cycloplegic refraction, Scheimpflug corneal tomography and pachymetry, and slit-lamp examination of corneal clarity with a minimum follow-up of 30 months. RESULTS: Both treated eyes experienced rapid healing of the epithelial surface within 5 days and progressive improvement of vision. In the first case, partial treatment reduced the astigmatism and aberrations, allowing for successful soft contact lens wear at 3 months. Follow-up at 13, 19, 30, and 36 months showed progressive reduction of refractive myopia and keratometric power. In the second case, laser treatment led to a near emmetropic refraction with an uncorrected visual acuity of 20/20 at 3 months, which remained unchanged at 21 and 30 months postoperative. CONCLUSIONS: Partial topography-guided PRK followed by riboflavin/UVA CXL is a safe and effective therapy that halts the progression of keratoectasia and reduces the spherocylindrical refraction and aberrations to improve the visual function of patients with progressive keratoconus. Stability and progressive improvement over time is observed, although limitations may exist for steeper and thinner corneas.

AB - PURPOSE: To follow the stability of a simultaneously delivered therapy that corrects aberrations and stiffens the corneal collagen of eyes with progressive keratoconus. METHODS: Two patients with progressive keratoconus underwent partial treatment (70% cylinder and sphere up to 50-μm central depth) with topographic customized photorefractive keratectomy (PRK) using the T-CAT module of the ALLEGRETTO WAVE Eye-Q excimer laser (Alcon Laboratories Inc), and then immediate corneal collagen cross-linking (CXL) with riboflavin 0.1% drops every 2 minutes while exposed to mean 365-nm ultraviolet A (UVA) light at 3.0 mW/cm2 for 30 minutes (the Athens Protocol). Pre- and postoperative evaluations included manifest and cycloplegic refraction, Scheimpflug corneal tomography and pachymetry, and slit-lamp examination of corneal clarity with a minimum follow-up of 30 months. RESULTS: Both treated eyes experienced rapid healing of the epithelial surface within 5 days and progressive improvement of vision. In the first case, partial treatment reduced the astigmatism and aberrations, allowing for successful soft contact lens wear at 3 months. Follow-up at 13, 19, 30, and 36 months showed progressive reduction of refractive myopia and keratometric power. In the second case, laser treatment led to a near emmetropic refraction with an uncorrected visual acuity of 20/20 at 3 months, which remained unchanged at 21 and 30 months postoperative. CONCLUSIONS: Partial topography-guided PRK followed by riboflavin/UVA CXL is a safe and effective therapy that halts the progression of keratoectasia and reduces the spherocylindrical refraction and aberrations to improve the visual function of patients with progressive keratoconus. Stability and progressive improvement over time is observed, although limitations may exist for steeper and thinner corneas.

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