Outcome of Topography-Guided PRK With CXL for Ectasia After LASIK
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
Fifty-six eyes of 54 patients with contact-lens intolerant, post-LASIK ectasia were treated using Wavelight Allegretto laser (WA) 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
Thirty-five of 56 eyes treated by the WA laser had sufficient data at 6 months for analysis. 19 of 35 (54%) showed UCVA ≥20/40. 23 (66%) had improved BCVA and 10 eyes (29%) gained two or more lines. No patient showed progression. Mean reduction in astigmatism (RIA) was 2.47±1.87D. All but 3 patients symptomatically improved. Complications were delayed epithelialization beyond one week in 3 patients and visually symptomatic haze in one.
Conclusion
Early results of TG-PRK with CXL showed 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.