Artikel
Controversy: Corneal collagen crosslinking and PRK should be combined – PRO
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Autoren
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A. John Kanellopoulos
- Laservision. gr Institute, Eye Institute of Laser, Athen, Griechenland
| Veröffentlicht: | 18. Oktober 2013 |
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Gliederung
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Purpose: To investigate the long term refractive, topometric, pachymetric, and visual rehabilitation changes on keratoconus management with anterior surface normalization by partial, topography-guided PRK with high-fluence CXL.
Patients and methods: 231 KCN cases subjected to the Athens Protocol (AP) procedure were studied pre-operatively and postoperatively for visual acuity, keratometry, pachymetry, and anterior surface irregularity indices progression for up to 3-years post-operatively with the Pentacam camera.
Results: UDVA change at the three-year visit, +0.38 ± 0.31 (range -0.34 to +1.10), and CDVA, +0.20 ± 0.21 (range -0.32 to +0.90), respectively.
Preoperatively, K1 (flat meridian) keratometry was 46.56 ± 3.83. At the first recorded postoperative 1-month visit, K1 was 44.44 ± 3.97 D (range 55.50 to 36.10 D), and up to the 36-month visit, K1 was average of 43.22 ± 3.80 D (range 53.70 to 36.00 D). Pre-operatively, K2 (steep meridian) keratometry was on average, 50.71 ± 5.14 D (range 66.62 6o 42.60), one month postoperatively, 47.61 ± 5.15 D (range 62.75 to 38.00), and up to the 36 month visit, K2 reached an average of 46.30 ± 4.91 D (range 60.00 to 37.20).
The Index of Surface Variance (ISV) was, preoperatively average, 98.48 ± 43.47, and up to the 3-year visit, 76.80 ± 38.41. The Index of Height Decentration (IHD) was preoperatively 0.091 ± 0.053, and at the 3-year, 0.057 ± 0.040 (0.208 to 0.001).
Preoperative Thinnest Corneal Thickness (TCT) was 451.91 ± 40.02 µm. One month postoperatively was 353.95 ± 53.90 µm and gradually increased to an average of 370.52 ± 58.21 µm.
Conclusions: The Athens Protocol procedure, aiming to arrest the keratoconus ectasia progression, and to improve corneal regularity through anterior topometry indices and visual performance, demonstrates safe and effective results as a management option.
Progressive potential for long term flattening documented in this study validates our employment of caution in the degree of the surface normalization process, in order to avoid overcorrection.
