TopographyGuided Photorefractive Keratectomy TGPRK for Keratoconus KC with

Topography-Guided Photorefractive Keratectomy (TG-PRK) for Keratoconus (KC) with Simultaneous Collagen Cross-linking (CXL) Using High-Resolution Excimer Laser Simon Holland David TC Lin ASCRS, Chicago, Illinois 2012 Purpose *no financial interests* To evaluate efficacy and safety of simultaneous TG-PRK with CXL using high-resolution excimer laser, i. VIS

Methods § 43 eyes keratoconus eyes underwent treatment with high resolution excimer laser § Trans-epithelial TG-PRK with i. VIS using the CIPTA program with simultaneous CXL (Dresden protocol) § Maximum refractive error corrected with minimal residual stromal depth 300 microns § Data evaluated: pre-operative, 1, 2, 3 and 6 months: - uncorrected visual acuity (UVA), best corrected visual acuity (BCVA), topography, manifest refraction (MR), symptom score, topography and keratometry

i. VIS TG-PRK with CXL for KC Pre-op UCVA: CF MR: -4. 50 -1. 00 x 080 Aim: – 1. 50 3 Months Post-op UCVA: 20/80 MR: -1. 50 x 150 20/30+

i. VIS TG-PRK with CXL for KC Pre-operative 4 months post-op UCVA: CF UCVA: 20/50 MR: -6. 50 -4. 75 X 110 20/60+ MR: -1. 00 -1. 25 x 180 20/40 -

Results § 43 eyes completed 6 months follow-up § 18 (42%) had ≥ 20/40 or better uncorrected visual acuity (UVA) § 36 (84%) had ≥ 20/40 or better best corrected visual acuity (BCVA) § 16 (37%) had BCVA improved, 4 (9%) improved BCVA 2 lines or more, 15 (35%) no change, 2 (5%) lost 2 lines or more § Mean astigmatism decreased -2. 67 D pre-op to -1. 50 D § 3 had delayed epithelial healing beyond 5 days with no residual effects and no other complications § Symptom scores at 3 months, n=20, improved in 11, no change in 5 and worse in 4

Conclusions § Early results of simultaneous TG-PRK with CXL with the high-resolution excimer laser, i. VIS, shows potential to improve both UCVA and BSCVA in CL intolerant KC patients with good efficacy and safety § Advantages include central corneal regularization possible with the i. VIS CIPTA program but may be offset by smaller treatment zones and less reduction in symptoms