Outcome of Topography-Guided Photorefractive Keratectomy With Crosslinking for Ectasia After LASIK

Monday, April 28, 2014: 3:01 PM
Room 151B (Boston Convention and Exhibition Center)
Simon P. Holland, MB, FRCSC, University of British Columbia, Vancouver, BC, Canada
David T. Lin, MD, FRCSC, Pacific Laser Eye Centre, Vancouver, BC, Canada
Johnson Tan, MBBS, FRCSEd (Ophth), The University of British Columbia, Vancouver, BC, Canada

Narrative Responses:

Purpose
To evaluate early results of topography-guided photorefractive keratectomy (TG-PRK) with simultaneous collagen cross-linking (CXL) for ectasia after laser assisted in situ keratomileusis (LASIK).

Methods
51 eyes of 35 patients with  contact-lens intolerant, post-LASIK ectasia were treated using Allegretto Wavelight laser (AW) TG-PRK with simultaneous CXL. Trans epithelial PRK was performed with a custom Topographical Neutralization Technique (TNT).  Pre and post-operative assessment of symptoms, uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), manifest refraction (MR) predictability, and safety were analyzed

Results
31 of 51 eyes treated by the AW laser had sufficient data at 6 months for analysis. 18 of 31 (59%) showed UCVA ≥20/40. 20 (64%) had improved BCVA and 16 eyes (52%) gained two or more lines.   No patient showed progression.  Mean reduction in astigmatism (RIA) was 2.65D. All but 3 patients symptomatically improved. Complications were delayed epithelialization beyond one week in 2 patients and visually symptomatic haze in one.

Conclusion
Early results of TG-PRK with CXL show efficacy and safety for treatment for post-LASIK ectasia. All but 3 had improved symptoms. More than half achieved UCVA of 20/40 and also improved BSCVA. This study demonstrates an alternative treatment for highly symptomatic patients with post-LASIK ectasia with contact lens intolerance