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Simon Holland David T.C Lin WCCVI April 2010 *authors have no financial interests

Topographically-guided Photorefractive Keratectomy(TG-PRK) for keratoconus (KC) with neutralization (TNT) and simultaneous collagen cross-linking. Simon Holland David T.C Lin WCCVI April 2010 *authors have no financial interests. Purpose.

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Simon Holland David T.C Lin WCCVI April 2010 *authors have no financial interests

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  1. Topographically-guided Photorefractive Keratectomy(TG-PRK) for keratoconus (KC) with neutralization (TNT) and simultaneous collagen cross-linking Simon Holland David T.C Lin WCCVI April 2010 *authors have no financial interests

  2. Purpose • To evaluate the efficacy, predictability, and safety of topographically-directed photorefractive keratectomy (TG-PRK) in contact lens intolerant keratoconus using the Wavelight Allegretto laser with and without collagen cross-linking

  3. Methods • A topographical neutralization technique (TNT) was used to estimate the refractive change on a plano topographical treatment using the Wavelight Allegretto laser • Treatment was modified based on the manifest refraction • 36 eyes of 22 patients underwent trans-epithelial TG-PRK • Best corrected vision (BSCVA) and eccentricity were evaluated at three, six, and twelve months (Group 1) • Additional 27 eyes received simultaneous CXL (Group 2) with an adjusted nomogram

  4. Pre-op: UVA: 20/100 BCVA: 20/60, +1.75-1.25X75 9 months post-op: UVA: 20/50 BCVA: 20/25-, +2.50sph

  5. Pre-op: UVA: 20/150 BCVA: 20/30+2, -1.75-0.75X75 4 months post-op: UVA:20/20 BCVA: 20/20, -0.50-0.50X125

  6. Pre-op: UVA: 20/300 BCVA: 20/30-, -3.50-5.50X65 4 months post-op: UVA:20/60 BCVA: 20/40, -0.50-3.50X20

  7. Pre-op: UVA: 20/300 BCVA: 20/40-, -4.25-4.00X75 4 months post-op: UVA:20/50 BCVA: 20/30, -0.75-1.00X135

  8. Pre-op: UVA:CF BCVA: 20/30, -5.50-4.75x55 2.5 months post-op: UVA:20/40 BCVA: 20/30+, -0.25-0.50X95

  9. Pre-op: UVA: BCVA: 20/40-, -6.00-5.00X135 2.5 months post-op: UVA:20/200 BCVA: 20/30, -2.50-1.00X50

  10. Results • Improved uncorrected vision (UCVA) was achieved in 32 out of 36 eyes at 12 months with improved best corrected vision (BSCVA) in 19/36 • 16 unchanged and two eyes lost two lines (Group 1) • In the cross-linking group (2), 23/27 eyes had improved UCVA and one lost >2 lines requiring corneal transplant

  11. Conclusions: Contact lens intolerant keratoconus patients considering corneal transplants or ring segments may have an alternative with Topo-directed PRK Topographic cylinder – poor correlation with refractive cylinder (ORA) Topographic neutralizing technique (TNT) to refine refractive algorithms Outcomes better with forme fruste and mild keratoconus – Investigational Topographical neutralization is an effective method for improving results in Topo-directed PRK in KC patients Simultaneous collagen cross-linking may add to long term stability, but early results are inconclusive

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