Journal of refractive surgery (Thorofare, N.J. : 1995) · 2026
Biomechanical, Visual, and Refractive Outcomes of Total Corneal Wavefront-Guided Transepithelial PRK With Accelerated CXL in Keratoconus Using Objective Stability Markers.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Haro-Morlett Luis, Arba-Mosquera Samuel, Hernandez-Solis Angelica, Hernandez Aldo, Ramirez-Miranda Arturo, Navas Alejandro, Graue-Hernandez Enrique O
Аннотация
PURPOSE: To evaluate the long-term safety and efficacy of simultaneous total corneal wavefront-guided transepithelial photorefractive keratectomy (TCWG-TransPRK) with accelerated corneal cross-linking (CXL) in mild to moderate keratoconus, incorporating corneal biomechanics as objective markers of structural stability.
METHODS: This prospective, interventional, single-center study included patients with mild to moderate keratoconus. All underwent TCWG-TransPRK (maximum planned stromal ablation: 55 µm) followed by accelerated CXL (30 mW/cm2 for 3 minutes; total fluence: 5.4 J/cm2). Follow-up was conducted at 24 hours, 1 week, and 1, 3, 6, and 12 months. Primary outcomes were safety and efficacy, with stress-strain index version 2 (SSI v2) proposed as a key objective marker of biomechanical stability. Additionally, refractive accuracy, tomography, and epithelial remodeling were evaluated.
RESULTS: Thirty-eight eyes from 19 patients were analyzed. At 12 months, uncorrected distance visual acuity improved from 0.80 ± 0.36 to -0.03 ± 0.10 logarithm of the minimum angle of resolution (P < .0001), with 87% achieving 20/20 and all 20/40 or better. Corrected distance visual acuity improved (P < .0001), with no Snellen line loss. Refractive accuracy was high (89% within ±1.00 diopter). SSI v2 increased significantly (P < .0001), indicating enhanced intrinsic stiffness. No keratoconus progression was observed. Epithelial thickness increased nasally and temporally, correlating with changes in spherical aberration and vertical trefoil.
CONCLUSIONS: Despite the use of accelerated CXL parameters, TCWG-TransPRK with CXL improved vision and enhanced biomechanical stability, as evidenced by a significant increase in SSI v2. This provides an objective structural marker for monitoring and customizing keratoconus care. These findings support the procedure as a safe and effective option for non-progressive mild to moderate keratoconus.
METHODS: This prospective, interventional, single-center study included patients with mild to moderate keratoconus. All underwent TCWG-TransPRK (maximum planned stromal ablation: 55 µm) followed by accelerated CXL (30 mW/cm2 for 3 minutes; total fluence: 5.4 J/cm2). Follow-up was conducted at 24 hours, 1 week, and 1, 3, 6, and 12 months. Primary outcomes were safety and efficacy, with stress-strain index version 2 (SSI v2) proposed as a key objective marker of biomechanical stability. Additionally, refractive accuracy, tomography, and epithelial remodeling were evaluated.
RESULTS: Thirty-eight eyes from 19 patients were analyzed. At 12 months, uncorrected distance visual acuity improved from 0.80 ± 0.36 to -0.03 ± 0.10 logarithm of the minimum angle of resolution (P < .0001), with 87% achieving 20/20 and all 20/40 or better. Corrected distance visual acuity improved (P < .0001), with no Snellen line loss. Refractive accuracy was high (89% within ±1.00 diopter). SSI v2 increased significantly (P < .0001), indicating enhanced intrinsic stiffness. No keratoconus progression was observed. Epithelial thickness increased nasally and temporally, correlating with changes in spherical aberration and vertical trefoil.
CONCLUSIONS: Despite the use of accelerated CXL parameters, TCWG-TransPRK with CXL improved vision and enhanced biomechanical stability, as evidenced by a significant increase in SSI v2. This provides an objective structural marker for monitoring and customizing keratoconus care. These findings support the procedure as a safe and effective option for non-progressive mild to moderate keratoconus.
Предметные рубрики MeSH
HumansKeratoconusCorneal Cross-LinkingProspective StudiesVisual AcuityPhotorefractive KeratectomyFemaleRefraction, OcularAdultCross-Linking ReagentsBiomechanical PhenomenaCorneal TopographyRiboflavinMalePhotosensitizing AgentsLasers, ExcimerYoung AdultCollagenCorneaUltraviolet RaysCorneal StromaElasticityFollow-Up StudiesEpithelium, CornealTreatment Outcome