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Three-years outcomes of simultaneous photorefractive surgery and customized corneal cross-linking for keratoconus

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Abstract

Purpose

To report the efficacy of customized cross-linking (CXL) in halting progression of keratoconus when combined with photorefractive procedures.

Methods

Seven eyes from 7 patients with documented progressive keratoconus were treated with customized CXL (customized ultraviolet-A irradiance pattern centered on the maximum posterior elevation with total energy levels ranging from 5.4 up to 10 J/cm2 , and an energy fluence of 9 mW/cm2) combined with photorefractive procedures. Four patients underwent simultaneous transepithelial photorefractive keratectomy (T-PRK) plus customized CXL, and three patients underwent simultaneous transepithelial phototherapeutic keratectomy (T-PTK) plus customized CXL. Tomographic parameters (Kmax, pachymetry of the thinnest point and maximal elevation of posterior float and regularization index) and best spectacle-corrected visual acuity (BSCVA) were compared preoperatively and 3 years postoperatively.

Results

All eyes showed a decrease in the maximal curvature Kmax, and none of eyes showed progression. Six eyes showed a flattening of 3 or more diopters (D). On average, Kmax decreased by − 4.8 ± 2.5 D, and the BSCVA improved by 0.04 ± 0.07 logarithm of the minimal angle of resolution. The mean value of regularization index was 8.7 ± 3.8 D. Mild corneal haze occurred in two eyes, and superficial apical scar occurred in one eye. None of the eyes had a vision-threatening complication.

Conclusion

Customized CXL combined with photorefractive procedure (T-PRK/T-PTK) resulted in long lasting flattening effect and strong regularization of keratoconic corneas along with improvement of BSCVA over a 3-year follow-up.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Majed S. Alkharashi & Mohammed M. Abusayf

  2. Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia

    Rakan S. Al-Essa

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  1. Majed S. Alkharashi
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  3. Mohammed M. Abusayf
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Contributions

MSA: conception and design of the study, overall review and editing of the manuscript. RSA: Literature review, data collection, data analysis and drafting the manuscript. MMA: overall review and editing of the manuscript. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Rakan S. Al-Essa.

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Competing interests

The authors declare no competing interests.

Ethical approval

The study was approved by the Institutional Review Board (IRB) at King Saud University, Riyadh, Saudi Arabia. This study adhered to the ethical principles outlined in the Declaration of Helsinki as amended in 2013.

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Patients signed an informed consent prior to enrollment in the study.

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Alkharashi, M.S., Al-Essa, R.S. & Abusayf, M.M. Three-years outcomes of simultaneous photorefractive surgery and customized corneal cross-linking for keratoconus. Int Ophthalmol 43, 2963–2969 (2023). https://doi.org/10.1007/s10792-023-02703-4

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  • DOI: https://doi.org/10.1007/s10792-023-02703-4

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