Topography-Guided Photorefractive Keratectomy (TG-PRK) for Keratoconus (KC) with

Simultaneous Collagen Cross-linking (CXL) Using High-Resolution Excimer Laser

Simon HollandDavid 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 KCPre-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

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-

iVIS TG-PRK with CXL for KC

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

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