1. Prospective Objective Analysis of Corneal Haze Following Customized Transepithelial PRK Without Mitomycin C Combined With Accelerated Corneal Cross-Linking Versus Corneal Cross-Linking Alone.
- Author
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Awwad ST, Bteich Y, Assaf JF, Ghosn A, Hafezi F, Torres-Netto E, Chacra LM, and Kozhaya K
- Subjects
- Humans, Prospective Studies, Female, Male, Adult, Young Adult, Ultraviolet Rays, Combined Modality Therapy, Corneal Cross-Linking, Photorefractive Keratectomy methods, Cross-Linking Reagents therapeutic use, Visual Acuity physiology, Photosensitizing Agents therapeutic use, Mitomycin administration & dosage, Refraction, Ocular physiology, Keratoconus drug therapy, Keratoconus physiopathology, Keratoconus metabolism, Riboflavin therapeutic use, Lasers, Excimer therapeutic use, Corneal Stroma metabolism, Photochemotherapy methods, Corneal Opacity physiopathology, Corneal Opacity etiology, Tomography, Optical Coherence, Collagen metabolism, Corneal Topography
- Abstract
Purpose: To compare haze and refractive outcomes in patients undergoing combined accelerated corneal cross-linking (A-CXL) and selective wavefront-guided transepithelial photorefractive keratectomy (WG-transPRK) without mitomycin C (MMC) versus those undergoing A-CXL., Methods: This prospective study analyzed 95 eyes (86 patients) with progressive keratoconus from October 2018 to October 2022. The first group underwent CXL combined with corneal or ocular WG-transPRK (CXL+PRK, n = 52), targeting higher order aberrations (HOAs). The second underwent CXL only (n = 43), both following the same accelerated CXL protocol without MMC on the SCHWIND Amaris laser platform (SCHWIND eye-tech-solutions). Baseline and postoperative evaluations (1, 3, 6, and 12 months) included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, tomography, corneal HOAs, and optical coherence tomography (OCT) scans. A patented machine learning algorithm objectively detected and quantified stromal haze on OCT scans in grayscale units., Results: In both groups, anterior corneal haze reflectivity and subepithelial haze peaked at 3 months postoperatively, then progressively decreased at 6 and 12 months. Haze did not differ between groups at any time point. By 12 months, CDVA increased by 2.5 lines in the CXL+PRK group ( P < .001) and by 0.7 lines in the CXL group ( P = .10), and maximum keratometry decreased from 51.70 ± 5.10 to 47.90 ± 7.90 diopters (D) (CXL+PRK group) ( P < .001) and from 51.20 ± 5.10 to 50.30 ± 4.60 D (CXL group) ( P = .004). Corneal HOAs decreased in both groups but more in the CXL+PRK group., Conclusions: Combining CXL with WG-transPRK without MMC does not result in increased haze when compared to A-CXL alone. This combined approach achieves greater improvements in visual, topographic, and aberrometric parameters. [ J Refract Surg . 2024;40(9):e583-e594.] .
- Published
- 2024
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