Comparison of t-PTK + CXL and CXL with mechanical debridement for keratoconus: fellow eye study
International Ophthalmology, cilt.45, sa.1, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 45 Sayı: 1
- Basım Tarihi: 2025
- Doi Numarası: 10.1007/s10792-025-03867-x
- Dergi Adı: International Ophthalmology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, EMBASE, MEDLINE
- Anahtar Kelimeler: Corneal cross-linking, Keratoconus, Mechanical debridement, Transepithelial phototherapeutic keratectomy
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Purpose: To compare visual, refractive, tear function, and ocular surface outcomes of accelerated corneal cross-linking (CXL) performed with transepithelial phototherapeutic keratectomy (t-PTK) versus mechanical epithelial debridement in fellow eyes of patients with keratoconus. Methods: This retrospective, comparative, fellow-eye study included 52 eyes of 26 keratoconus patients, each with a thinnest corneal thickness greater than 450 µm before the procedure, who underwent accelerated CXL with two different epithelial removal techniques. One eye received t-PTK-assisted epithelial removal and the fellow eye mechanical debridement. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UCVA), refractive and topographic parameters, higher-order aberrations (HOAs), tear function tests, pain scores, epithelial healing time, and demarcation line depth were assessed up to 12 months postoperatively. Results: Epithelial healing time and pain scores were comparable between groups (p > 0.05). Demarcation line depth and endothelial cell counts showed no significant difference. At postoperative month 12, the t-PTK group demonstrated significantly improved CDVA and UCVA, reduced spherical equivalent, keratometric values, corneal astigmatism, and total HOAs, whereas no significant improvements were observed in the mechanical group. Tear break-up time significantly decreased in both groups, while Schirmer test results and corneal staining remained unchanged. No significant haze was detected in either group. Conclusion: While epithelial healing, ocular surface parameters, and safety outcomes were similar between techniques, t-PTK-assisted epithelial removal provided superior long-term visual, refractive, and topographic improvements compared with mechanical debridement. Accelerated CXL following t-PTK may offer enhanced therapeutic benefit for selected keratoconus patients.