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Cross-linking combined with transepithelial PTK yields better results
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Corneal collagen cross-linking yielded better visual and refractive outcomes when combined with transepithelial phototherapeutic keratectomy than when combined with mechanical epithelial debridement, a study found.
The prospective study included 38 eyes of 34 patients with a mean age of 28 years who had progressive keratoconus and underwent corneal collagen cross-linking. Sixteen patients underwent cross-linking with transepithelial phototherapeutic keratectomy (PTK), and 18 patients underwent cross-linking with mechanical epithelial debridement using a rotating brush.
Visual outcomes, refractive outcomes and corneal confocal microscopy were evaluated preoperatively and at 1, 3, 6 and 12 months after surgery.
In the transepithelial PTK group, mean logMAR uncorrected distance visual acuity improved from 0.99 preoperatively to 0.63 at 12 months. The improvement was statistically significant (P < .05).
Mean corrected distance visual acuity improved from 0.30 preoperatively to 0.19 at 12 months. The improvement was significant (P = .008). Improvements in corrected distance visual acuity at 1, 3 and 6 months were insignificant.
Mean corneal astigmatism improved from –5.84 D preoperatively to –4.31 D at final follow-up (P = .015).
In the mechanical debridement group, uncorrected distance visual acuity, corrected distance visual acuity and corneal astigmatism did not have significant improvements at 12 months.
No intraoperative or postoperative complications or changes in endothelial cell density were reported in either group, the authors said.
Perspective
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Eric D. Donnenfeld, MD, MD
This study evaluated the effect of riboflavin ultraviolet cross-linking when performed with either phototherapeutic keratectomy (PTK) or mechanical epithelial removal. The results show superior outcomes in improved visual acuity, corneal flattening and astigmatism reduction using excimer laser PTK. Interestingly, the authors found no improvement in visual acuity or astigmatism reduction at 1 year with mechanical epithelial removal. This result is not supported by several previous studies that have shown improvement in these parameters with mechanical epithelial removal. However, a superior outcome with PTK would be expected by having the laser ablate through the epitheliuim in the periphery, and at the apex of the cone, where the epithelium is thinnest, there would be a small amount of stromal removal, which would flatten the cone.
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