1. Accelerated CXL Combined with Same Day PTK and Single Intrastromal Ring Segment Implantation
for Keratoconus
Yakov Goldich, Noa Avni-Zauberman , Randall Ulate, Mauricio A. Perez, David Rootman
Department of Ophthalmology, Toronto Western Hospital, University of Toronto
The authors have no conflicts of interest and no financial interest in the article’s subject matter or methods mentioned.

2. The authors have no conflicts of interest and no financial interest in the article’s subject matter or methods mentioned.

3. Introduction:
Visual impairment in keratoconus is usually progressive and results from induced myopia, irregular astigmatism and corneal scarring.
Treatment paradigm aims visual rehabilitation along with reducing or stopping the natural progression of the disease.
Intrastromal corneal ring segments (ICRS) were previously described as an effective modality causing flattening of astigmatic cornea and improving visual acuity.
Corneal collagen crosslinking (CXL) has been shown as an effective way to halt keratoconic progression and improve visual acuity and astigmatism.

4. Introduction:
Accelerated corneal collagen crosslinking (a-CXL, 10 minutes) using increased optical intensity to shorten treatment time and intrastromal corneal ring segments (ICRS’s) having larger cross-sectional diameter and smaller inner optical zone (Intacs-SK0.5mm) were recently added to our armamentarium.

5. Purpose:
The aim of this study was to evaluate the outcomes of the combined same day transepithelial phototherapeutic keratectomy (t-PTK) with Intacs-SK0.5mm and a-CXL treatment in keratoconic patients.

6. Methods:
This retrospective study included consecutive patients with advanced keratoconus undergoing combined same day treatment including transepithelial PTK followed by femtosecond laser assisted ICRS implantation followed by accelerated CXL.

7. Methods:
All patients had an inferiorly decentered asymmetric cone associated with a flat superior cornea as established with placido based corneal topography (Nidek OPD-Scan III, Gamagori, Japan) and with Scheimplug based corneal tomography (Pentacam, Oculus, Wetzlar, Germany).

8. Results:
Nineteen eyes of twelve patients (4 females and 8 males) aged 30.3 ± 11.7 years (range years) were included.
There was an improvement in visual acuity with both UDVA and CDVA showing statistically significant change and improving respectively (logMAR) from 0.71 ± 0.4 preoperatively to 0.45 ± 0.3 (p=0.007) postoperatively and from 0.28 ± 0.2 to 0.16 ± 0.1 (p=0.016).
Postoperative corneal flattening was noted with statistically significant change in maximal simK, minimal simK and mean simK (p≤0.001) and significant reduction of steepest K (p=0.014).
The total HOA was statistically significantly reduced from 5.7 ± 1.7 µm preoperatively to 3.8 ± 1.7 µm postoperatively (p<0.001).

9. Results:

10. Conclusions
Our study shows that t-PTK combined with one ICRS and a-CXL performed sequentially on the same day in keratoconic patients improves visual acuity, decreases keratometry readings and reduces total HOA’s.

11. Thank you