A Novel Procedure for Keratoconus/Corneal Ectasia Treating Epithelial Compensation of Higher-Order Aberrations, Topographic Guided Ablation, and Corneal Cross Linking – The CREATE+CXL Protocol

Manoj Motwani Cornea Revolution/Motwani LASIK Institute, San Diego, CA, 92121, USACorrespondence: Manoj Motwani, Cornea Revolution/Motwani LASIK Institute, 8710 Scranton Road, Ste 170, San Diego, CA, 92121, USA, Tel +1 858 554-0008, Email drmmlj@gmail.comPurpose: To present the outcomes of a retrospective study in keratoconus/corneal ectasia patients of treating the higher order aberrations compensated for the corneal epithelium in addition to topographic guided ablation followed by corneal cross linking.Methods: Twenty-seven eyes of 14 patients were treated for keratoconus/corneal ectasia utilizing trans-epithelial topographic guided ablation photorefractive keratectomy (PRK) for treatment of corneal higher order aberrations and lower order astigmatism followed immediately by 15-minute cross linking were examined retrospectively. Six-month results were analyzed via measurement of vision, refraction, residual higher-order aberrations (HOAs), residual lower-order and higher-order aberrations, as well as for loss or gains of lines of best corrected visual acuity.Results: All eyes save one had reduction in K1, K2, K Max, and K Mean. All eyes had reduction in manifest astigmatism, Contoura measured astigmatism, 57% reduction of higher-order aberrations (HOA), and 53% reduction of higher-order aberrations grouped with lower-order aberrations (Grouped). Nearly all (96.3%) eyes achieved 20/40 vision or better, 20 eyes had 1– 7 lines gained of vision, and no eyes had any loss of lines of vision.Conclusion: Use of the CREATE+CXL protocol combined with 15-minute corneal cross linking results in a significant increase in HOA reduction, as well as a significant improvement in corrected distance visual acuity over past procedures.Keywords: astigmatism, corneal cross linking, higher-order aberrations, keratoconus, lower-order aberrations, photorefractive keratectomy, corneal ectasia