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Beitragstitel | One-year clinical experience with PACE (Second generation customized corneal cross-linking) to reduce corneal topographical asymmetry and improve vision in patients with keratoconus and ectasia after LASIK |
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Beitragscode | P20 |
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Präsentationsform | ePoster |
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Abstract-Text |
Purpose PTK-assisted customized epi-on (PACE) corneal cross-linking (CXL) is a new method developed by ELZA which involves a PTK (phototherapeutic keratotomy) over the cone while avoiding any stromal tissue removal. Several gradients are created to achieve the customized effect: First, the PTK area is an epi-off CXL area as opposed to the rest of the cornea, which is treated in an epi-on fashion. Second, once riboflavin is applied, it generates a riboflavin gradient with highest concentrations in the epithelium-denuded region. A differential UV gradient is also applied, where the highest fluences are delivered over the cone. PACE achieves substantial corneal flattening, several diopters greater than first-generation customized CXL. Setting ELZA Institute, Dietikon, Zurich, Switzerland. Methods This prospective study involved PACE being performed on 122 eyes with ectasia (keratoconus, n=118; post-laser refractive surgery ectasia, n=4). We report on the 1-year topographic, tomographic and visual outcomes of eyes with either stable or progressive corneal ectasia that underwent PACE cross-linking. The procedure was performed by one of two surgeons (FH, ETN) at a single site (ELZA Institute, Zurich). All patients underwent a comprehensive assessment of corneal topography and tomography using (Pentacam, Oculus; MS-39, CSO Italia), corneal biomechanics (Corvis ST, Oculus) and conventional visual acuity assessments before PACE, and at regular intervals post-surgery, as well as at the one-year follow-up visit. Results We will show how PACE successfully reduces corneal topographical asymmetry by up to 12 D and will detail the changes in topographic and biomechanical parameters reflecting corneal flattening and asymmetry reduction. Subgroup analyses will reveal demographic and pre-procedural corneal characteristics linked to significant flattening and regularization effects, alongside visual outcomes. assess if these effects are consistent across progressive and non-progressive ectasias. Conclusions By exploiting both riboflavin and UV light gradients, PACE cross-linking can deliver greater corneal regularization effects than earlier customized cross-linking approaches, without removing any stromal tissue. PACE improves the quality of vision by not only flattening the steep areas of the keratoconus, but also by a coupling effect that regularizes the astigmatism in the upper cornea. |