An article from the Open Opthalmology Journal written by 3 doctors from Emmetropia Mediterranean Eye Clinic, Elefteria Square 44, Heraklion, Crete 71201, Greece. This article was written to analyse visual, refractive and topographic outcomes of combining transepithelial photorefractive keratectomy (tPRK) with simultaneous corneal crosslinking for the visual rehabilitation of contact lens intolerant keratoconus patients.
Keratoconus is the most common keratectasia, where thinning and irregularity of the cornea result in visual disability, with often profound impact on young patients. Current mainstream therapy is the use of rigid contact lenses, with keratoplasty reserved for severe cases of contact lens intolerance. Emerging therapies include intrastromal ring segments and photorefractive keratectomy (PRK) in addition to collagen crosslinking therapy (CXL), which aims to stabilize rather than improve visual function. Current regimes for PRK utilize topographically guided profiles, intended to regularise the corneal surface and improve vision.
The aim of the current study was to evaluate a novel transepithelial PRK protocol where, in contradiction to previous studies, topographic treatment planning and profiles were not used. This was combined with simultaneous CXL. This treatment was utilized for contact lens intolerant patients with visually disabling keratoconus, for whom further conventional therapy would involve keratoplasty.
Do also note that there were initial concerns regarding potential haze. However, it was mentioned that in this and a previous transepithelial PRK study, "haze was insignificant". This shows that haze occurs in very few individuals after TransPRK.
It was concluded that non-topographic transepithelial PRK with simultaneous crosslinking improves vision, and may offer an alternative to keratoplasty in contact lens intolerant keratoconus. Further comparative studies to topographic PRK techniques are indicated.