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Identifier

000417878

Title

Μελέτη της διασύνδεσης του κερατοειδικού κολλαγόνου σε συνδυασμό με την διεπιθηλιακή φωτοθεραπευτική κερατεκτομή για την αντιμετώπιση των εκτατικών παθήσεων του κερατοειδούς

Alternative Title

Corneal collagen cross-linking combined with transepithelial phototherapeutic keratectomy for the treatment of corneal ectatic disorders

Author

Γρέντζελος, Μιχαήλ Α.

Thesis advisor

Σιγανός, Χαράλαμπος

Reviewer

Κιμιωνής, Χαράλαμπος
Παλλήκαρης, Ιωάννης
Τσιλιμπάρης, Μιλτιάδης
Δετοράκης, Ευστάθιος
Βελεγράκης, Γεώργιος
Γραβάνης, Αχιλλέας
Θερμού, Κυριακή

Abstract

Purpose: Evaluation of effectiveness and safety of a new surgical technique regarding the combination of transepithelial phototherapeutic keratectomy and corneal collagen cross-linking, with or without simultaneous conventional photorefractive keratectomy, for the treatment of keratoconus, the most usual corneal ectatic disorder. Methods: Eighty-one patients (97 eyes) with progressive keratoconus underwent corneal collagen cross-linng wιth riboflavin and ultraviolet A. Twenty patients (23 eyes) underwent combined transepithelial phototherapeutic keratectomy and corneal collagen cross-linking (Cretan protocol), forty-three patients (55 eyes) underwent combined transepithelial phototherapeutic keratectomy and conventional photorefractive keratectomy followed simultaneously by corneal collagen cross-linking (Cretan protocol plus), while 18 patients (19 eyes) underwent corneal collagen cross-linking with mechanical epithelial debridement (Dresden protocol). Visual, refractive and topographic outcomes and the endothelial cell density were evaluated preoperatively and postoperatively. Results: There were no intraoperative or postoperative complications in any of the patients (eyes). Stabilization of keratoconus and halt of the progression of the ectatic disorder was observed in all eyes. In eyes undergone combined transepithelial phototherapeutic keratectomy and corneal collagen crosslinking, uncorrected and corrected distance visual acuity, steep and flat keratometric values, and corneal astigmatism improved significantly postoperatively. The improvement for each of these parameters was observed from a different postoperative timepoint to the end of the postoperative follow-up. Eyes undergone combined transepithelial phototherapeutic keratectomy and conventional photorefractive keratectomy followed simultenaously by corneal collagen cross-linking, all of the above parameters improved significantly postoperatively even from the first postoperative month. Eyes undergone corneal collagen cross-linking with mechanical epithelial debridement, even though stabilization of keratoconus and halt of the progression of the ectatic disorder was observed, however, none of the above parameters showed significant improvement 8 postoperatively. No endothelial cell density alterations were observed throughout the follow-up period. Conclusions: This new combined surgical technique of transepithelial phototherapeutic keratectomy and corneal collagen cross-linking, with or without simultaneous conventional photorefractive keratectomy seems to result not only in corneal stabilization but also in vision improvement of the patients. Thus, this new combined technique (Cretan protocol) seems to be an effective and safe alternative treatment for the management of keratoconus, the most usual corneal ectatic disorder.

Language

Greek

Subject

CXL

Combined technique

Conventional photorefractive keratectomy

Cornea

Corneal cross-linking

Cretan protokol

Keratoconus

PRK

PTK