Treatment of Keratoconus with WaveLight Contoura and Corneal Cross-Linking Combined

Abstract

Purpose

To investigate the outcomes of the treatment of keratoconus/corneal ectasia utilizing topographic-guided ablation (WaveLight Contoura) followed by corneal cross-linking.

Methods

Thirty-six eyes of 21 patients were treated for keratoconus/corneal ectasia utilizing topographic guided ablation photorefractive keratectomy (PRK) for treatment of corneal higher-order aberrations and refractive error followed immediately by 15-minute cross-linking were examined retrospectively. Six-month results were analyzed via measurement of vision, refraction, residual higher-order aberrations (HOAs), residual lower-order and higher-order aberrations, as well as for loss or gains of lines of best-corrected visual acuity.

Results

All eyes save one had reduction in K1, K2, K Max, K Mean. All eyes had reduction in manifest astigmatism, Contoura-measured astigmatism, higher-order aberrations, higher-order aberrations grouped with lower-order aberrations (Grouped). Four eyes had lost 1–2 lines of vision, mainly to corneal haze formation, 17 eyes gained lines of vision, and 15 eyes equaled their pre-op best-corrected visual acuity. Eight eyes from four sample patients have their data included in this manuscript to demonstrate the procedure and the outcomes.

Conclusion

Treatment with WaveLight Contoura combined with 15-minute corneal cross-linking is an effective and safe treatment for keratoconus and should be considered a primary treatment to prevent corneal transplant as well as improve vision and corneal irregularity.

Keywords:

• astigmatism
• best-corrected visual acuity
• corneal cross-linking
• higher-order aberrations
• keratoconus
• topographic-guided ablation

Abbreviations

BCVA, best-corrected visual acuity; CXL, corneal cross-linking; D, diopters; ETM, epithelial thickness maps; FDA, Food and Drug Administration; HHS, Health and Human Services; HOAs, higher-order aberrations; LASIK, laser-assisted in situ keratomileusis; K MAX, maximum keratometry value; MMC, mitomycin C; OCT, optical coherence tomography; OD, right eye; OS, left eye; PRK, photorefractive keratectomy; PRN, pro re nata or as needed; PTK, phototherapeutic keratectomy; qd, daily; qid, 4 times daily; RGP, rigid gas permeable; UCVA, uncorrected visual acuity; US, United States; UV, ultraviolet.

Acknowledgments

The author would like to thank Julie Crider, PhD, for editing contributions.

Disclosure

Dr Manoj Motwani reports a patent issued (U.S. patent nos. 10,857,032 and 10,857,033). The author reports no other conflicts of interest in this work.