Biomechanical, Visual, and Refractive Outcomes of Total Corneal Wavefront-Guided Transepithelial PRK With Accelerated...

Area of Science:

• Ophthalmology
• Corneal Surgery
• Biomechanical Engineering

Background:

• Keratoconus is a progressive eye condition causing thinning and bulging of the cornea.
• Current treatments aim to halt progression and improve vision, but long-term biomechanical stability is crucial.

Purpose of the Study:

• To assess the safety and efficacy of simultaneous total corneal wavefront-guided transepithelial photorefractive keratectomy (TCWG-TransPRK) combined with accelerated corneal cross-linking (CXL).
• To evaluate the impact on corneal biomechanics, using the stress-strain index version 2 (SSI v2) as an objective marker of structural stability in mild to moderate keratoconus.

Main Methods:

• A prospective, single-center study involving patients with mild to moderate keratoconus.
• Patients underwent TCWG-TransPRK followed immediately by accelerated CXL (30 mW/cm² for 3 minutes).
• Evaluations included visual acuity, refractive accuracy, tomography, epithelial remodeling, and SSI v2 over 12 months.

Main Results:

• Significant improvement in uncorrected and corrected distance visual acuity at 12 months (P < .0001).
• High refractive accuracy (89% within ±1.00 D) and no observed keratoconus progression.
• A significant increase in SSI v2 (P < .0001) indicated enhanced corneal stiffness and biomechanical stability.

Conclusions:

• Simultaneous TCWG-TransPRK with accelerated CXL is safe and effective for mild to moderate keratoconus.
• The procedure improves visual outcomes and enhances corneal biomechanical stability, with SSI v2 serving as an objective marker.
• This combined approach offers a promising option for managing non-progressive keratoconus.