Long-Term Comparison of Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Cross-linking versus Corneal Cross-linking Alone.
Détails
ID Serval
serval:BIB_474F20CDFD99
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Long-Term Comparison of Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Cross-linking versus Corneal Cross-linking Alone.
Périodique
Ophthalmology
ISSN
1549-4713 (Electronic)
ISSN-L
0161-6420
Statut éditorial
Publié
Date de publication
05/2016
Peer-reviewed
Oui
Volume
123
Numéro
5
Pages
974-983
Langue
anglais
Notes
Publication types: Clinical Study ; Comparative Study ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
To compare the results of corneal collagen cross-linking (CXL) alone with combined simultaneous topography-guided photorefractive keratectomy plus CXL (tPRK-CXL) for progressive keratoconus for a 3-year interval.
Prospective, comparative interventional case series.
Forty-eight patients (60 eyes) with progressive keratoconus.
Thirty eyes underwent combined tPRK with a solid-state laser (maximum ablation depth, 50 μm) followed by CXL, and 30 eyes underwent CXL alone. Groups were matched in terms of age and keratoconus stage.
Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), keratometry, and corneal confocal microscopy.
Mean follow up was 39±11 months. Mean age at operation was 28±5.82 years. Before surgery, average CDVA in the tPRK-CXL group was 0.26±0.17 logarithm of the minimum angle of resolution (logMAR), and in the CXL group was 0.24±0.18 logMAR (P = 0.58). At last follow-up, CDVA was 0.09±0.10 logMAR in the tPRK-CXL group and 0.15±0.12 logMAR in the CXL group (P < 0.05). In both groups, no patient lost more than 2 lines of Snellen visual acuity, whereas 19 eyes and 8 eyes in the tPRK-CXL group and in the CXL group, respectively, gained 2 or more lines of CDVA. Before surgery, average UDVA was 0.83±0.54 logMAR in the tPRK-CXL group and 0.86±0.62 logMAR in the CXL group (P = 0.79). At last follow-up, UDVA was 0.27±0.25 logMAR in the tPRK-CXL group and 0.69±0.58 logMAR in the CXL group (P < 0.001). Before surgery, steep and flat keratometry had no significant differences between groups, and at last follow-up, both steep and flat keratometry readings were significantly flatter in the tPRK-CXL group compared with the CXL group. Depth of CXL treatment, as evaluated by confocal microscopy, was 269.8±31.8 μm in the CXL group and 299.7±29.8 μm in the tPRK-CXL group (P < 0.001). No differences were found in endothelial cell density.
Simultaneous tPRK followed by CXL in this series of keratoconus patients offered significantly improved vision to treated patients in comparison with CXL alone, and similar results regarding postoperative stability. Safety concerns regarding corneal thickness were taken into account in treatment planning.
Prospective, comparative interventional case series.
Forty-eight patients (60 eyes) with progressive keratoconus.
Thirty eyes underwent combined tPRK with a solid-state laser (maximum ablation depth, 50 μm) followed by CXL, and 30 eyes underwent CXL alone. Groups were matched in terms of age and keratoconus stage.
Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), keratometry, and corneal confocal microscopy.
Mean follow up was 39±11 months. Mean age at operation was 28±5.82 years. Before surgery, average CDVA in the tPRK-CXL group was 0.26±0.17 logarithm of the minimum angle of resolution (logMAR), and in the CXL group was 0.24±0.18 logMAR (P = 0.58). At last follow-up, CDVA was 0.09±0.10 logMAR in the tPRK-CXL group and 0.15±0.12 logMAR in the CXL group (P < 0.05). In both groups, no patient lost more than 2 lines of Snellen visual acuity, whereas 19 eyes and 8 eyes in the tPRK-CXL group and in the CXL group, respectively, gained 2 or more lines of CDVA. Before surgery, average UDVA was 0.83±0.54 logMAR in the tPRK-CXL group and 0.86±0.62 logMAR in the CXL group (P = 0.79). At last follow-up, UDVA was 0.27±0.25 logMAR in the tPRK-CXL group and 0.69±0.58 logMAR in the CXL group (P < 0.001). Before surgery, steep and flat keratometry had no significant differences between groups, and at last follow-up, both steep and flat keratometry readings were significantly flatter in the tPRK-CXL group compared with the CXL group. Depth of CXL treatment, as evaluated by confocal microscopy, was 269.8±31.8 μm in the CXL group and 299.7±29.8 μm in the tPRK-CXL group (P < 0.001). No differences were found in endothelial cell density.
Simultaneous tPRK followed by CXL in this series of keratoconus patients offered significantly improved vision to treated patients in comparison with CXL alone, and similar results regarding postoperative stability. Safety concerns regarding corneal thickness were taken into account in treatment planning.
Mots-clé
Adolescent, Adult, Collagen/metabolism, Combined Modality Therapy, Corneal Stroma/metabolism, Corneal Topography, Cross-Linking Reagents, Female, Follow-Up Studies, Humans, Keratoconus/drug therapy, Keratoconus/metabolism, Keratoconus/surgery, Keratoconus/therapy, Lasers, Excimer/therapeutic use, Male, Microscopy, Confocal, Photochemotherapy, Photorefractive Keratectomy/methods, Photosensitizing Agents/therapeutic use, Prospective Studies, Riboflavin/therapeutic use, Ultraviolet Rays, Visual Acuity/physiology, Young Adult
Pubmed
Web of science
Création de la notice
30/09/2019 16:57
Dernière modification de la notice
06/10/2019 6:26
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