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Ana Laura Canedo, Ronald Gaster, Yaron Rabinowitz; Comparison of Laser-Assisted Removal of Epithelium to Mechanical Debridement in Corneal Cross-Linking for Progressive Keratoconus: 12-Months Results. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3112.
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To determine whether removing the epithelium with the laser (PTK) yields better outcomes than mechanical debridement of the epithelium in CXL treatments of patients with progressive keratoconus.
We analyzed UCVA, BCVA and central K values at 6 months in 67 patients (77 eyes) with progressive keratoconus who had undergone CXL. 16 patients (17 eyes) had their epithelium removed by laser (PTK) and 51 patients (60 eyes) had their epithelium removed by mechanical debridement (Dresden protocol). Statistical significance: p < 0.05
The mean number of lines of improvement in the PTK and mechanical groups were UCVA 1.53 ± 0.49 and 1.28 ± 0.40 lines, respectively; and BCVA 0.24 ± 0.16 and 0.57 ± 0.14 lines, respectively ( p>0.05). The central K values decrease by a mean of 1.35 ± 3.1 and 0.41 ± 3.5 respectively (p<0.05).
Laser-CXL appears to give superior visual results than manual epithelial debridement and may become the procedure of choice for CXL. A possible limitation of this technique is that thinning of the apex of the cone may expose the endothelium to increased toxic effects of the UV light. In our small series to date, endothelial cell counts have not been affected. Larger series of patients with longer follow up is needed before this treatment can be universally recommended.
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