Topography-guided customized PRK combined with simultaneous CXL in patients previously implanted ICRS for progressive keratoconus

1. Topography-guided customized PRK combined with
simultaneous CXL in patients previously implanted
ICRS for progressive keratoconus
Dominique PIETRINI, MD
Tony GUEDJ, OD, ORTH
CCK, Paris
Vision Breteuil, Paris
Clinique de la Vision, Paris
www.docteurpietrini.com

2. CORNEOPLASTIC PROCEDURES IN KERATOCONUS
• ICRS
• Topoguided PRK
• CXL
COMBINED TECHNIQUES
• ICRS+CXL
• Topoguided PRK + CXL
• ICRS+CXL+Topoguided PRK

3. PURPOSE
To evaluate safety and efficacy of topographyguided photorefractive keratectomy and
simultaneous CXL performed in patients with
progressive keratoconus previously implanted
intracorneal ring segment (ICRS)

4. MATERIAL AND METHODS
STUDY:
• 17 eyes , 15 patients
• 4 females , 11 males
• Consecutive case serie
Mean age: 26.5 years+/-3,9
Mean Sphere pre op: -3.03+/-3.06
Mean Cyl pre op: -4.34+/-2.12
Mean pachymetry pre op : 475.2µm+/-22,84
SELECTED INDICATIONS:
P

5. SURGICAL PROCEDURE
• Epithelial removal: Amoils brush
• Topoguided PRK (T-CAT Allegretto WaveLight)
• Less than 50 microns (depending on pre op pachy)
• Sphero cylindrical correction 70% of refraction
• Late hyperopic shift associated with CXL
• Always myopic target (not a refractive surgery)
• Refractive shift unpredictible because of various ablative
profiles.
• No mitomycine
• 20 mn riboflavin+ 30 mn UV-A

6. SPHERICAL EQUIVALENT AND KMAX
4.7D
Reduction
on SE
5D
Reduction
on Kmax

7. BEST AND UNCORRECTED DISTANCE VISUAL ACUITY
After Keraring:
Gain of 2 lines of UCVA
Gain of 0,8 lines of BCVA
After Topoguided CXL post Keraring:
Gain of 2,5 lines of UCVA
Gain of 1,8 lines of BCVA
Gain Total of 4.5 lines of UCVA after Triple Procedure
Gain Total of 2.5 lines of BCVA after Triple Procedure

8. COMPLICATIONS
• One case of paracentral scar
• Not haze but scar related to over CXL
• Default in evaluating thinnest point
• No loss of BCVA compared to preop
• Gain in refraction

9. M.M Male, 26 years
KMAX
58.8D
KMAX
52.8D
PRE OP
KERARING
6 MONTHS
UCVA
1/20
UCVA
2/10
BCVA
3/10
BCVA
5/10
REFRACTION
-8.50 (-5.00) 0°
REFRACTION
- 4.50

10. KERARING
6 MONTHS
PRE OP
-6D

11. M.M
MALE
26 YEARS

12. 7/10
9/10
KMAX+0.50 (-1.00) 30°
52.8D
KMAX
45.6D
KERARING
6 MONTHS
KERARING+TOPOLINK+CXL
9 MONTHS
UCVA
2/10
UCVA
7/10
BCVA
5/10
BCVA
9/10
REFRACTION
- 4.50
REFRACTION
+0.50 (-1.00) 30°

13. KERARING+TOPOLINK+CXL
9 MONTHS
KERARING
6 MONTHS
-7D

14. KMAX
58.8D
KMAX
45.6D
PRE OP
KERARING+TOPOLINK+CXL
9 MONTHS
UCVA
1/20
UCVA
7/10
BCVA
3/10
BCVA
9/10
REFRACTION
-8.50 (-5.00) 0°
REFRACTION
+0.50 (-1.00) 30°

15. KERARING+TOPOLINK+CXL
9 MONTHS
PRE OP
-13D

16. Conclusion
• TG PRK + CXL after ICRS is indicated when
• KC is progressive
• Visual result after ICRS is poor
• If corneal pachymetry > 450 microns
• TG PRK +CXL after ICRS
• Improves significantly the reduction of spherocylindrical
refraction and K max
• improves UCVA by 2.5 lines
• and BCVA 1.8 line.
• Triple procedure combining “topo-guided” PRK + CXL in
patients previously implanted with Keraring is safe and
effective in a short term