Transepithelial phototherapeutic keratectomy enhances visual outcomes of collagen cross-linking

HYDERABAD, India — Epithelial removal using transepithelial phototherapeutic keratectomy during corneal collagen cross-linking results in better visual and refractive outcomes compared to mechanical epithelial debridement, according to one surgeon.

“It is proved that the epithelium at the keratoconus apex is thinner than in the surrounding area. Transepithelial [phototherapeutic keratectomy] allows the excimer laser, set at 50 µm, to ablate the epithelium but also a few microns of stroma at the apex, smoothening the corneal surface before [cross-linking],” Vardhaman Kankaria, MD, said at the joint meeting of the Asia-Pacific Academy of Ophthalmology and All India Ophthalmological Society.

Vardhaman Kankaria, MD

This results in better visual outcomes after collagen cross-linking, he said.

In a study, 38 eyes with progressive keratoconus were divided into two groups, one treated with manual debridement and the other with transepithelial phototherapeutic keratectomy before cross-linking.

“At 1 year, distance vision and astigmatism showed significant improvement in the group treated with [transepithelial phototherapeutic keratectomy] compared to the other group,” Kankaria said.

The procedure is easy, reproducible and skill-independent, Kankaria said. Further studies are needed to validate its use in eyes with keratoconus to remove the epithelium and smooth the corneal surface before cross-linking for better visual outcomes.

Disclosure: Kankaria has no relevant financial disclosures.