Combined Transepithelial Phototherapeutic Keratectomy and Corneal Collagen Cross-Linking for Progressive Keratoconus

Purpose: To compare the outcomes of corneal collagen cross-linking (CXL) for the treatment of progressive keratoconus using 2 different techniques for epithelial removal: transepithelial phototherapeutic keratectomy (t-PTK) versus mechanical epithelial debridement. Design: Prospective, comparative, interventional case series. Participants: Thirty-four patients (38 eyes) with progressive keratoconus were enrolled. Methods: All patients underwent uneventful CXL treatment. Sixteen patients (19 eyes) underwent epithelial removal using t-PTK (group 1) and 18 patients (19 eyes) underwent mechanical epithelial debridement using a rotating brush (group 2) during CXL treatment. Visual and refractive outcomes were evaluated along with corneal confocal microscopy findings preoperatively and at 1, 3, 6, and 12 months postoperatively. Main Outcome Measures: Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, and keratometry readings. Results: No intraoperative or postoperative complications were observed in any of the patients. In group 1, logarithm of the minimum angle of resolution mean UDVA and mean CDVA improved from 0.99 +/- 0.71 and 0.30 +/- 0.26 preoperatively to 0.63 +/- 0.42 (P = 0.02) and 0.19 +/- 0.18 (P = 0.008) at 12 months postoperatively, respectively. In group 2, neither mean UDVA nor mean CDVA demonstrated a significant improvement at 12 months postoperatively (P > 0.05). In group 1, mean corneal astigmatism improved from -5.84 +/- 3.80 diopters (D) preoperatively to -4.31 +/- 2.90 D (P = 0.015) at the last follow-up, whereas in group 2 there was no significant difference at the same postoperative interval (P > 0.05). No endothelial cell density alterations were observed throughout the follow-up period for both groups (P > 0.05). Conclusions: Epithelial removal using t-PTK during CXL results in better visual and refractive outcomes in comparison with mechanical epithelial debridement. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. Ophthalmology 2012; 119: 1777-1784 (C) 2012 by the American Academy of Ophthalmology.