Topography-guided Transepithelial Surface Ablation Followed by Corneal Collagen Cross-linking Performed in a Single Combined Procedure for the Treatment of Keratoconus and Pellucid Marginal Degeneration

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Abstract
PURPOSE: To evaluate a combination of topography-guided custom ablation and corneal collagen cross-linking (CXL) in a single procedure for the treatment of keratectasia. METHODS: Twelve eyes of 12 patients with keratectasia were treated with topography-guided custom ablation and CXL. Topography-guided custom ablation was performed using a transepithelial technique with the iVIS Suite 1 kHz flying spot excimer laser. Collagen cross-linking was performed immediately after topography-guided custom ablation, according to standard protocol. Postoperative follow-up examinations were performed at 1, 3, 6, and 12 months. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive change, corneal topography, and pachymetry were analyzed pre- and postoperatively. RESULTS: Mean UCVA increased from 20/1000 preoperatively to 20/125 12 months postoperatively. Mean BSCVA increased from 20/57 to 20/35, with no loss of lines of visual acuity. Mean astigmatism was reduced from 5.40±2.13 diopters (D) to 2.70±1.44 D, and keratometric asymmetry decreased from 6.38±1.02 D to 2.76±0.73 D. Only minor changes in posterior corneal surface elevation and stability of refraction were found, confirming that no progression of ectasia occurred during the observation time. CONCLUSIONS: A combination of topography-guided custom ablation and CXL improved patients' visual, refractive, and topography outcomes and halted the progression of keratectasia within the observation period of 12 months. This method may postpone or eliminate the need for corneal transplantation in suitable cases with keratectasia. [ J Refract Surg . 2010;26:145–152.]

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