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Ray-Tracing Transepithelial Excimer Laser Central Corneal Remodeling Plus Pachymetry-Guided Accelerated Corneal
Cosimo Mazzotta1,2,3, Aleksandar Stojanovic4, Vito Romano5,6
1Department of Medicine, Surgery and Neurosciences, Postgraduate Ophthalmology School, Siena University, Italy.
Cornea
|September 12, 2023
Summary
Ray-tracing-guided transepithelial PRK combined with accelerated crosslinking significantly improved vision in keratoconus patients. This tissue-preserving algorithm enhances visual acuity while minimizing corneal tissue removal.
Area of Science:
- Ophthalmology
- Corneal Surgery
- Vision Science
Background:
- Keratoconus (KC) is a progressive corneal ectasia affecting young adults.
- Current treatments aim to halt progression and improve visual acuity.
- Tissue-preserving surgical algorithms are crucial for long-term corneal health.
Purpose of the Study:
- To evaluate the long-term (12-96 months) outcomes of a novel tissue-preservation algorithm for stable keratoconus.
- The algorithm combines ray-tracing-guided transepithelial excimer laser ablation (RT t-PRK) with individualized pachymetry-guided accelerated crosslinking (M nomogram ACXL).
- To assess the impact on visual acuity, corneal topography, and aberrations in young adult patients.
Main Methods:
- Prospective interventional study involving 38 eyes of 38 young adult patients (Stage II KC).
- Simultaneous RT t-PRK and pachymetry-based ACXL performed on the non-dominant eye.
- Utilized iViS Suite iRES Excimer Laser with CIPTA 2 software for treatment planning and Precisio 2/Sirius for diagnostics. Mean follow-up: 52 months.
Main Results:
- Mean uncorrected distance visual acuity (UDVA) improved by 3.5 Snellen lines (SL); 38% gained ≥ 4 SLs.
- Mean best spectacle-corrected visual acuity (BSCVA) increased by 4.3 SL; 68% gained ≥ 4 SLs.
- No eyes lost visual acuity; the procedure demonstrated significant visual gains and safety.
Conclusions:
- The combination of RT t-PRK and ACXL offers significant visual quality improvement for keratoconus patients.
- This integrated approach effectively halts disease progression while preserving corneal tissue.
- The M nomogram ACXL strategy minimizes overcorrection and tissue consumption, enhancing patient outcomes.
