title: Corneal-Wavefront guided transepithelial photorefractive keratectomy after corneal collagen cross linking in keratoconus.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of Corneal-Wavefront guided transepithelial photorefractive keratectomy (TransPRK) after corneal collagen cross linking (CXL) in keratoconic patients.
  
  
  METHODS
  In this retrospective, non-comparative, consecutive case series, 39 keratoconic eyes underwent Corneal-Wavefront guided TransPRK for the correction of aberrations at least 4 months after conventional CXL at SEKAL Rovigo Microsurgery Centre, Rovigo, Italy. Two eyes (5%) underwent a secondary laser retreatment for the improvement of post-operative visual acuity and were not included in this retrospective analysis. The mean age of the patients was 35±12 years (19-64 years) at the time of the surgery. Keratron-Scout (Optikon) topographer was used for diagnostic tests and a flying-spot laser (AMARIS; SCHWIND eye-tech-solutions) was used for the refractive surgery. Complete ophthalmic examinations were performed before and after the surgery (4-36 months postoperatively with a mean follow up time of 10±8 months).
  
  
  RESULTS
  Preoperatively, eyes showed irregular astigmatism up to 8D. At last postoperative follow-up, 21 eyes (57%) had UDVA better than 20/40, and six eyes (16%) had UDVA of 20/20. Twenty-three eyes (62%) were within 1.50D of attempted correction in spherical equivalent (mean deviation from target was +1.09±2.36D, range -2.50 to +7.38D). No eye lost 2 Snellen lines of CDVA, and 15 eyes (41%) had an increase of more than 2 lines.
  
  
  CONCLUSIONS
  Corneal-Wavefront guided transepithelial PRK ablation profiles after conventional CXL yields to good visual, optical, and refractive results. These treatments are safe and efficacious for the correction of refracto-therapeutic problems in keratoconic patients.
authors.affiliation: SEKAL Rovigo Microsurgery Centre, Rovigo, Italy. Electronic address: massimo.camellin@sekal.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Camellin
authors.affiliation: Studio Medico Guidotti, Bologna, Italy.
authors.forename: Jacopo Maria
authors.initials: JM
authors.lastname: Guidotti
authors.affiliation: SCHWIND eye-tech-solutions, Kleinostheim, Germany.
authors.forename: Samuel
authors.initials: S
authors.lastname: Arba Mosquera
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism; D057108:Corneal Wavefront Aberration / Q000503:physiopathology / Q000601:surgery*; D003432:Cross-Linking Reagents / Q000627:therapeutic use; D019573:Epithelium, Corneal / Q000601:surgery*; D005260:Female; D006801:Humans; D007640:Keratoconus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen
keywords: Corneal collagen cross linking; Corneal-Wavefront guided; Entrecruzamiento del colágeno corneal; Keratoconus; Problemas refracto-terapéuticos; Queratectomía fotorrefractiva transepitelial; Queratocono; Refracto-therapeutic; Transepithelial photorefractive keratectomy; frente de onda corneal