Abstract

PURPOSE
To compare the outcomes of corneal collagen cross-linking (CXL) for the treatment of progressive keratoconus using 2 different techniques for epithelial removal: transepithelial phototherapeutic keratectomy (t-PTK) versus mechanical epithelial debridement.
DESIGN
Prospective, comparative, interventional case series.
PARTICIPANTS
Thirty-four patients (38 eyes) with progressive keratoconus were enrolled.
METHODS
All patients underwent uneventful CXL treatment. Sixteen patients (19 eyes) underwent epithelial removal using t-PTK (group 1) and 18 patients (19 eyes) underwent mechanical epithelial debridement using a rotating brush (group 2) during CXL treatment. Visual and refractive outcomes were evaluated along with corneal confocal microscopy findings preoperatively and at 1, 3, 6, and 12 months postoperatively.
MAIN OUTCOME MEASURES
Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and keratometry readings.
RESULTS
No intraoperative or postoperative complications were observed in any of the patients. In group 1, logarithm of the minimum angle of resolution mean UDVA and mean CDVA improved from 0.99 ± 0.71 and 0.30 ± 0.26 preoperatively to 0.63 ± 0.42 (P = 0.02) and 0.19 ± 0.18 (P = 0.008) at 12 months postoperatively, respectively. In group 2, neither mean UDVA nor mean CDVA demonstrated a significant improvement at 12 months postoperatively (P>0.05). In group 1, mean corneal astigmatism improved from -5.84 ± 3.80 diopters (D) preoperatively to -4.31 ± 2.90 D (P = 0.015) at the last follow-up, whereas in group 2 there was no significant difference at the same postoperative interval (P>0.05). No endothelial cell density alterations were observed throughout the follow-up period for both groups (P>0.05).
CONCLUSIONS
Epithelial removal using t-PTK during CXL results in better visual and refractive outcomes in comparison with mechanical epithelial debridement.

Links

Publisher Full Text

Authors

Kymionis GD, Grentzelos MA, Kounis GA, Diakonis VF, Limnopoulou AN, Panagopoulou SI

Institution

Institute of Vision and Optics (IVO), Faculty of Medicine, University of Crete, Heraklion, Crete, Greece. kymionis@med.uoc.gr

Source

Ophthalmology 119:9 2012 Sep pg 1777-84

MeSH

Adult
Collagen
Combined Modality Therapy
Corneal Stroma
Cross-Linking Reagents
Debridement
Disease Progression
Epithelium, Corneal
Female
Humans
Keratoconus
Lasers, Excimer
Male
Microscopy, Confocal
Photochemotherapy
Photorefractive Keratectomy
Photosensitizing Agents
Prospective Studies
Riboflavin
Ultraviolet Rays
Visual Acuity
Young Adult

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

22683058