Visual and Refractive outcomes and Aberrations of Simultaneous Wavefront Guided Photorefractive Keratectomy and Corneal Cross-Linking in Early Keratoconous.
Seyed Javad Hashemian MD1 *, Maryam Vazirinia MD1
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences and Iranian Eye Clinic, Tehran, Iran.
Abstract: To evaluate the safety, efficacy and aberration changes of simultaneous wavefront guided photorefractive keratectomy (WFG-PRK) and accelerated corneal cross-linking (ACXL) in early Keratoconous and low myopic astigmatism. Prospective, interventional, non-randomized, case series.
Methods: Fifty eyes of 29 patients (mean age: 30.76y) with mild, non-progressive (stages 1) Keratoconous and low myopic astigmatism were enrolled. Uncorrected (UDVA) and corrected distance visual acuity (CDVA), refraction, steep and flat keratometry readings, aberrometry and adverse events were evaluated, over 6.0 months of follow-up.
Results: All study parameters showed a statistically significant improvement at 6 months over baseline values. The mean follow-up time was 10.24±4.9mo (range: 6-24mo). Patients showed a significant improvement in UDVA from 1.2±0.29 logMAR prior to procedure to 0.10±0.14 logMAR postoperatively. CDVA significantly increased from 0.08±0.10 logMAR preoperatively to 0.02±0.06 postoperatively. A significant decrease in the mean spherical equivalent (SE) refraction was observed from -2.40±1.13 to -0.13±0.50 diopters (D) (P=0.00), and the manifest sphere decreased from -1.34±0.99 to -0.19±0.57 D (P=0.00). The manifest cylinder significantly decreased from -1.73±0.86 to -0.66±0.59 D postoperatively (P=0.00). The mean steep keratometry and mean steepest keratometry (Kmax) was 45.60±1.68, 46.44±1.6D preoperatively reduced significantly to 43.01±1.71, 44.09±1.77D respectively (P<0.05). Thirty-three (46%)eyes gained 1-3 line of CDVA. The total high order aberrations were decreased from 0.61±0.41 µm to 0.58±0.24(p=0.586). Ten eyes developed mild haze that responded well to a short course of topical steroids.
Conclusion: Combined WFG-PRK with accelerated CXL is an effective and safe option for correcting mild refractive error and improving visual function in patients with early stable Keratoconous.
