Transepithelial photorefractive keratectomy with crosslinking for keratoconus

Area of Science:

• Ophthalmology
• Corneal Surgery
• Vision Science

Background:

• Keratoconus is a progressive corneal ectasia causing irregular astigmatism and vision loss.
• Contact lens intolerance is a common challenge for keratoconus patients, often necessitating surgical intervention.
• Transepithelial photorefractive keratectomy (tPRK) and corneal crosslinking (CXL) are established treatments for keratoconus, but their combined application requires further investigation.

Purpose of the Study:

• To evaluate the visual, refractive, and topographic outcomes of tPRK combined with simultaneous CXL.
• To assess the efficacy of this combined approach for visual rehabilitation in contact lens intolerant keratoconus patients.

Main Methods:

• A prospective pilot study included 14 patients (22 eyes) with significant keratoconus, poor corrected vision, and contact lens intolerance.
• All participants underwent a single-step aspheric tPRK followed by sequential CXL.
• Preoperative and postoperative assessments (1, 3, 6, and 12 months) included visual acuity, refraction, corneal topography, and wavefront analysis.

Main Results:

• Postoperative unaided vision improved significantly (P<0.005), with best-corrected visual acuity also showing marked improvement (P<0.005).
• Mean postoperative cylinder was significantly reduced (P<0.005), indicating refractive improvement.
• Maximum keratometry (Kmax) remained stable throughout the follow-up period, suggesting stabilization of the corneal shape.

Conclusions:

• Combining tPRK with simultaneous CXL offers a promising treatment for visual rehabilitation in contact lens intolerant keratoconus.
• This approach may serve as an alternative to keratoplasty in select patients.
• Further comparative studies with topographic PRK techniques are warranted to fully elucidate its potential.