Topography-Guided Photorefractive Keratectomy (TG-PRK) for Keratoconus (KC) with Simultaneous Collagen Cross-linking (CXL) Using High-Resolution Excimer.

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

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Presentation transcript:

Topography-Guided Photorefractive Keratectomy (TG-PRK) for Keratoconus (KC) with Simultaneous Collagen Cross-linking (CXL) Using High-Resolution Excimer Laser Simon Holland David TC Lin ASCRS, Chicago, Illinois 2012 *no financial interests* Purpose To evaluate efficacy and safety of simultaneous TG-PRK with CXL using high-resolution excimer laser, iVIS

Methods 43 eyes keratoconus eyes underwent treatment with high resolution excimer laser Trans-epithelial TG-PRK with iVIS using the CIPTA program with simultaneous CXL (Dresden protocol) Maximum refractive error corrected with minimal residual stromal depth 300microns Data evaluated: pre-operative, 1, 2, 3 and 6 months: - uncorrected visual acuity (UVA), best corrected visual acuity (BCVA), topography, manifest refraction (MR), symptom score, topography and keratometry

iVIS TG-PRK with CXL for KC Pre-op 3 Months Post-op UCVA:CF UCVA: 20/80 MR: -4.50-1.00x080 MR: -1.50-1.50x150 20/30+ Aim: –1.50 Ginter, Aileen 3

iVIS TG-PRK with CXL for KC Pre-operative 4 months post-op UCVA: CF UCVA: 20/50- MR: -6.50-4.75X110 20/60+ MR: -1.00-1.25x180 20/40- Shi, Yan Bin OS 5

Shi, Yan Bin

Results 43 eyes completed 6 months follow-up 18 (42%) had ≥20/40 or better uncorrected visual acuity (UVA) 36 (84%) had ≥20/40 or better best corrected visual acuity (BCVA) 16 (37%) had BCVA improved, 4 (9%) improved BCVA 2 lines or more, 15 (35%) no change, 2 (5%) lost 2 lines or more Mean astigmatism decreased -2.67D pre-op to -1.50D 3 had delayed epithelial healing beyond 5 days with no residual effects and no other complications Symptom scores at 3 months, n=20, improved in 11, no change in 5 and worse in 4 Dr.Holland, please verify the words in RED. Please make correction and put OK at end of each. Thanks! 7

Conclusions Early results of simultaneous TG-PRK with CXL with the high-resolution excimer laser, iVIS, shows potential to improve both UCVA and BSCVA in CL intolerant KC patients with good efficacy and safety Advantages include central corneal regularization possible with the iVIS CIPTA program but may be offset by smaller treatment zones and less reduction in symptoms 8