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Clinical outcomes of topo guided PRK with collagen cross-linking in patients with keratoconus with mel 90 excimer laser

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First Author: N.R P INDIA

Co Author(s):    S. Ganesh   S. Brar                 

Abstract Details


To evaluate clinical outcomes of topo guided PRK (TG-PRK) with collagen crosslinking (CXL) in patients with keratoconus with MEL 90 excimer laser system.


Nethradhama Super Speciality Eye Hospital, Bengaluru, India


In this retrospective study, 70 eyes of 38 patients with early keratoconus with adequate pachymetry (≥ 450microns), low refractive error (SE ≤ 4 D) were selected for combined TG-PRK with CXL. Topography data from ATLAS was transferred into CRS master which then generated an ablation profile based on patient’s preoperative refraction and corneal aberrations. Treatment profile was then imported into MEL 90 (Carl Zeiss Meditec, Germany). Laser treatment followed by accelerated cross-linking was performed. Visual and refractive outcomes and aberrations were analysed at the end of 1 year.


At 1 year, mean BCVA (log MAR) reduced from 0.25± 0.26 to 0.1 ± 0.07 (p <0.05). Mean SE(D) and cylinder(D) reduced from -1.70 ±1.33 to -0.96 ±1.15 (p <0.05) and -1.90±1.28 to -1.35±1.2 (p <0.05) respectively. There was a change in mean thinnest pachymetry (microns), K1, K2, K mean(D) from 493.09± 38.27, 44.39±2.28, 46.84± 2.53, 45.62±2.18 to 420.92±62.25(p <0.05), 43.18±2.36, 45.44±2.71, 44.27±2.46 respectively. Higher order aberrations reduced from1.39±0.78 to 1.16±0.89(RMS). Mean demarcation line depth on AS-OCT was 212±15 microns. None of the eyes had any evidence of visually significant haze at 1 year.


TG-PRK with accelerated CXL performed with MEL 90 was safe and effective in management of early keratoconus and provided satisfactory visual outcomes.

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