Topography-Guided Photorefractive Keratectomy (TG-PRK) for Keratoconus (KC) With Simultaneous Collagen Cross-Linking (CXL): Excimer Laser - PowerPoint PPT Presentation

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Topography-Guided Photorefractive Keratectomy (TG-PRK) for Keratoconus (KC) With Simultaneous Collagen Cross-Linking (CXL): Excimer Laser

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Topography-Guided Photorefractive Keratectomy (TG-PRK) for Keratoconus (KC) With Simultaneous Collagen Cross-Linking (CXL): Excimer Laser – PowerPoint PPT presentation

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Title: Topography-Guided Photorefractive Keratectomy (TG-PRK) for Keratoconus (KC) With Simultaneous Collagen Cross-Linking (CXL): Excimer Laser


1
Topography-Guided Photorefractive Keratectomy
(TG-PRK) for Keratoconus (KC) With Simultaneous
Collagen Cross-Linking (CXL) Excimer Laser
  • Simon Holland
  • David TC Lin
  • ASCRS, Chicago, Illinois 2012
  • No financial interests

Purpose
  • To evaluate efficacy and safety of simultaneous
    TG-PRK for KC with simultaneous CXL

2
Methods
  • 127 keratoconus eyes underwent treatment with
    Allegretto excimer laser
  • Treatment targeted at -1.25 post-op, with minimal
    residual stromal depth 300microns
  • Epithelial removal by trans-epithelial laser
  • Topography-guided PRK, T-CAT software, modified
    by TNT (topographical neutralization)
  • Riboflavin 0.1 in dextran, until aqueous
    staining
  • UV irradiation with riboflavin (up to 20 minutes)
  • UV 370 um, 3mW/cm2 - 5.4 J/m2
  • Hypotonic dextran if lt400 um
  • Bandage contact lens, standard post PRK
  • management

3
TG-PRK CXL for KERATOCONUS
Pre-op 1.75-4.00x060 6 months post-op BSCVA
20/30- UCVA 20/30
RX
0.25-0.75x170 20/25
4
(No Transcript)
5
TG-PRK CXL for KERATOCONUS
Pre-operative 6 months post-op UCVA 20/60
UCVA 20/40 MR 2.25-2.00X120 20/40- MR
-0.50-0.50X60 20/30-
6
(No Transcript)
7
TG CXL PRK for KERATOCONUS
Pre-op -2.75-2.25x010 12 months
post-op BSCVA 20/20- UCVA
20/30-
RX 0.50-0.50x020 20/30-
8
(No Transcript)
9
Results
  • 99 eyes completed 6 months follow-up
  • 53 (54) had 20/40 or better uncorrected visual
    acuity (UVA)
  • 92 (93) had 20/40 or better best corrected
    visual acuity (BCVA)
  • 51 (52) had BCVA improved, 32 (32) improved
    BCVA 2 lines or more, 33 (33) no change, 4 (4)
    lost 2 lines or more
  • Mean astigmatism decreased -2.77D pre-op to
  • -1.14D
  • 4 had delay in epithelial healing with subsequent
    haze, 2 developed haze sufficient to reduce BCVA
    more than 2 lines, 1 had herpetic keratitis 3
    recovered pre-operative BCVA.
  • Glare, halos, and difficulties with night driving
    decreased from 3.5 to 2.0 on a 4 point score
    (n25)

10
Conclusions
  • Simultaneous TG-PRK with CXL using customized TNT
    technique shows promise to improve both UCVA and
    BCVA in keratoconus patients with reasonable
    efficacy and safety
  • Longer term results are needed to establish value
    and safety of combining attempted refractive
    correction and topographical regularization with
    collagen cross linking
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