title: Transepithelial phototherapeutic keratectomy combined with implantation of a single inferior intrastromal corneal ring segment and collagen crosslinking in keratoconus.
abstract: OBJECTIVE
  To evaluate the efficacy of phototherapeutic keratectomy (PTK) combined with implantation of a single inferior intrastromal corneal ring segment (ICRS) and riboflavin with ultraviolet-A collagen crosslinking (CXL) performed sequentially on the same day in the management of keratoconus.
  
  
  METHODS
  Cornea Unit, Toronto Western Hospital, Toronto, Ontario, Canada.
  
  
  METHODS
  Case series.
  
  
  METHODS
  This retrospective review comprised consecutive patients with progressive keratoconus having transepithelial PTK followed by femtosecond laser-enabled placement of a single inferior ICRS and CXL on the same day by the same surgeon between December 2010 and August 2011. The main outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), mean refraction spherical equivalent, keratometry (K), and total higher-order aberrations.
  
  
  RESULTS
  Sixteen eyes of 13 patients were included in the study. Six months after same-day PTK combined with implantation of a single inferior ICRS and CXL, there was a significant improvement in UDVA, CDVA, and the mean and steep K values. No patient lost CDVA lines.
  
  
  CONCLUSIONS
  Phototherapeutic keratectomy combined with implantation of a single inferior ICRS and CXL on the same day was a safe, effective treatment for improving visual acuity in select patients with progressive keratoconus.
authors.affiliation: Yonge Eglinton Laser Eye Centre and the Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. sonia.y@gmail.com
authors.forename: Sonia N
authors.initials: SN
authors.lastname: Yeung
authors.forename: Stephanie A W
authors.initials: SA
authors.lastname: Low
authors.forename: Judy Y F
authors.initials: JY
authors.lastname: Ku
authors.forename: Alejandro
authors.initials: A
authors.lastname: Lichtinger
authors.forename: Peter
authors.initials: P
authors.lastname: Kim
authors.forename: Joshua
authors.initials: J
authors.lastname: Teichman
authors.forename: Alfonso
authors.initials: A
authors.lastname: Iovieno
authors.forename: David S
authors.initials: DS
authors.lastname: Rootman
mesh_terms: D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000378:metabolism / Q000601:surgery*; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery / Q000628:therapy*; D008297:Male; D010778:Photochemotherapy; D018903:Photorefractive Keratectomy; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011379:Prognosis; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D012256:Riboflavin / Q000627:therapeutic use; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin