Jonathan E Moore
Cathedral Eye Clinic, UK
Title: Accelerated visual recovery in transepithelial phototherapeutic keratectomy in comparison to mechanical epithelial removal followed by cross-linking for progressive keratoconus
Biography
Biography: Jonathan E Moore
Abstract
Purpose: To evaluate the outcomes of a series of patients who were treated with either simultaneous transepithelial phototherapeutic keratectomy (trans-PTK) or mechanical epithelial removal prior to corneal collagen crosslinking (CXL) for progressive keratoconus. Methods: This study was a retrospective non-randomized comparative case series on 60 progressive keratoconic eyes (60 patients) who underwent epithelial debridement with trans-PTK using Amaris excimer laser (Schwind, GmbH) (group 1; 30 eyes) or mechanical epithelial debridement (group 2; 30 eyes) for epithelial removal prior to CXL (3mW/cm2) for 30 minutes using 0.1% topical riboflavin sodium phosphate. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, pachymetry (Topcon, Inc), corneal tomography indices (Oculus Pentacam), differences among anterior and posterior corneal surfaces (Oculus Pentacam), and subjective questionnaires were analysed. Follow up was six months. Results: No complications were observed in either group. Group 1: mean UDVA, CDVA and Kmax improved from 0.83±0.42 logMAR, 0.30±0.22 logMAR and 48.71±4.00 dioptres (D) preoperatively to 0.55±0.19 log MAR (P<0.05), 0.19±0.15 logMAR (P<0.05) and 46.36±4.49D (P<0.05) at six months, respectively; additionally in group 2, 0.80±0.23 logMAR, 0.26±0.18 logMAR and 46.35±4.55D preoperatively improved to 0.62±0.18 logMAR (P<0.05), 0.21±17 logMAR (P<0.05) and 45.47±4.65D (P<0.05) at six months, respectively. The mean magnitude of change observed in UDVA, CDVA, Kmax and QOV scores of group 1 was greater than group 2 (six months). Conclusions: Initial findings suggest that epithelial removal using trans-PTK during CXL results in possible early enhanced visual and refractive outcomes compared with mechanical epithelial debridement. Long-term follow up is required.