Introducing a Revised Tissue Saving Protocol for Combined Topography-Guided Photorefractive Keratectomy and Cross-Linking in Keratoconic Corneas

Abstract

Purpose:The aim of this study was to introduce a revised tissue-saving technique for combined topography-guided photorefractive keratectomy (PRK) and cross-linking for keratoconus (KC) treatment and to evaluate its efficacy, safety, and stability.Methods:This retrospective, noncontrolled study was performed at Maadi Eye Subspecialty Center and Eye Care Center, Cairo, Egypt. The technique was performed on virgin keratoconic corneas with 3 different morphological patterns of ectasia. It involves performing topography-guided PRK before epithelial removal, followed by customized phototherapeutic keratectomy (PTK) that is tailored to each cornea after studying the treatment profile on the laser treatment screen. The electronic medical records were explored for preoperative and postoperative data, including subjective refraction and topographic data (using Sirius topographer).Results:The study was conducted on 123 eyes of 93 patients with a mean age of 27.98 years ±6.06. The follow-up ranged from 6 to 36 months (mean ± SD of 16.2 months ±10.4). The results showed statistically nonsignificant differences among the 3 ectasia subgroups in treatment spherical equivalent, treatment maximum depth, thickness of removed epithelium, and thinnest residual stromal bed. There were statistically significant differences in almost all values between the preoperative and postoperative data, with significant postoperative patients' improvement (P value <0.001). The subgroups' results were almost the same as the whole cohort's results. The safety and efficacy indices of the performed procedure showed remarkably high values (1.48 ± 0.21 and 0.87 ± 0.40, respectively).Conclusions:This revised protocol for KC management maximally preserves stromal tissue with proven efficacy, safety, and stability.

Application of a Revised Tissue Saving Protocol for Combined Topography-Guided Photorefractive Keratectomy and Cross-Linking in a Cohort Having Pellucid Marginal Degeneration

“…As per the present study’s results, our revised tissue-saving protocol can be efficiently and safely used on a wide scale in cases of PMD, and it is not only successful in cases of KC as previously published. 19 The included cohort of PMD cases ranged from mild to severe ectatic conditions (for instance, preoperative Kmax readings ranged from 48.54 to 64.92 D), and all the results were satisfactory from both topographic and visual aspects.…”

“…This is the case for KC and its less common peripheral counterpart, namely PMD. The present study addressed a cohort of cases that had PMD and evaluated the efficacy, safety, and stability of a newly introduced revised tissue-saving protocol of management that was previously published by our research team 19 with promising results for KC cases. This is the first report documenting its results for cases of PMD.…”

“…The details of the performed procedures and the methods adopted for maximal tissue saving while keeping a safe procedure are all detailed in our previously published work on KC patients. 19 …”

Novel Technique to Improve the Efficacy of Corneal Cross Linking in Cases of Post LASIK Ectasia

“…We have previously published our proposed novel treatment protocol for managing KC cases with variable degrees, 13 with proven efficacy, safety, and stability. The technique has also shown very promising visual and topographic outcomes in managing cases of post LASIK ectasia as per the present study results.…”

“…10 Our team has recently published a modified, tissue saving protocol for combined PRK and CXL for keratoconus (KC) management, with proven efficacy, safety, and stability. 13 The primary outcome of the present study was to evaluate the efficacy, safety, and stability of this novel protocol in cases with post LASIK ectasia, while the secondary outcome was to compare the results of such a novel technique to the conventional CXL protocol in post LASIK ectasia management.…”