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R. R. Krueger, A. J. Kanellopoulos; Simultaneous Topo-Guided PRK and Riboflavin/UVA Crosslinking for the Correction of Progressive Keratoconus. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5483.
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To introduce a simultaneously delivered therapy that both corrects aberrations and stiffens the corneal collagen of eyes with progressive keratoconus.
Two patients with progressive keratoconus underwent partial treatment with topographic customized photorefractive keratectomy (PRK) in the worse eye, and then were immediately cross-linked with riboflavin 0.1% drops every 5 minutes while exposed to 365 nm ultraviolet (UVA) light at 3.0 mW/cm2 for 30 minutes. Pre and postoperative testing included manifest and cycloplegic refraction, corneal topography, pachymetry and slit lamp examination of corneal clarity with followup at 3, 6 and 12 months.
Both treated eyes experienced rapid healing of the epithelial surface within 5 days and progressive improvement of vision. In the first case, partial treatment primarily reduced the astigmatism and aberrations, leading to a residual myopic refraction which allowed for successful wear of a soft contact lens. In the second case, laser treatment led to a near emmetropic refraction with an uncorrected visual acuity of 20/20 at 3 months and beyond. In both cases, the outcome remained stable with no shift in refraction or topography over the first postop year.
Topo-guided PRK followed by riboflavin/UVA cross-linking is a safe and effective therapy that both halts the progression of keratoectasia and significantly reduces the spherocylindrical refraction and aberrations to improve the visual function of patients with progressive keratoconus.
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