A Novel Procedure for Keratoconus/Corneal Ectasia Treating Epithelial Compensation of Higher-Order Aberrations, Topographic Guided Ablation, and Corneal Cross Linking – The CREATE+CXL Protocol

Figures & data

Table 1 Pre-Op and Post-Op Values for Average K and Kmax, Pre-Op Measured and Manifest Cylinder, and Post-Op Manifest Cylinder

	Avg. Kmax	Avg. K	Measured Cyl	Manifest Cyl
Pre-op	53.62 D (44.6–61.4)	45.49 D (32.7–52.10)	3.56 D (0.9–7.64)	2.37 D (0–6.5)
Post-op 6 mos	49.41 D (43.6–71.5)	43.54 D (37.3–51.9)	Not measured	1.07 D (0–6)

Abbreviations: Cyl, cylinder; D, diopter.

Table 2 Best Corrected Visual Acuities Pre-Op and Post-Op by Snellen Chart Measurements

BCVA	Pre-Op Eyes	Avg. Percentage	Post-Op Eyes	Avg. Percentage
20/15	0	0	1	3.7%
20/20	5	18.5%	13	48.15%
20/25	6	22.22%	8	29.63%
20/30	6	22.22%	3	11.11%
20/40	2	7.41%	1	3.7%
20/50	2	7.41%	0	0
20/60	3	11.11%	0	0
20/70	2	7.41%	0	0
20/80	1	3.7%	1	3.7%

Abbreviations: Avg, average; BCVA, best-corrected visual acuity.

Table 3 Gains in Best Corrected Visual Acuity

Lines of Vision Gained of BCVA	Number of Eyes	Percentage
0	7	25.92%
1	9	33.33%
2	4	14.81%
3	2	7.41%
4	1	3.7%
5	3	11.11%
6	0	0
7	1	3.7%

Abbreviation: BCVA, best-corrected visual acuity.

Table 4 Zernike Polynomials for 6th Order Higher-Order Aberrations and for Grouped Polynomials

	HOA 5	Grouped
Pre-op avg. microns	0.943 (0.26–2.1)	1.3 (0.46–2.5)
Post-op avg. microns	0.403 (0.2–1.4)	0.61 (0.11–1.2)
Avg. Reduction	57.27% (6.3–83.3%)	52.8% (6.9–64.1%)

Abbreviations: Avg, average; HOA, higher-order aberrations.

Table 5 Average Amount of Epithelial Compensation of the Stroma

	All Eyes	Eyes with <3D of Contoura Cylinder
Average Epithelial Compensation in microns (range)	18.92 (8–47)	48.58 (25–85)
Total Contoura Measured HOA depth in microns (range)	59.51 (23–92)	19.58 (10–47)
Total Aberration in microns	78.43	69.16
Epithelial compensation as % of HOA	24.1%	28%

Abbreviation: HOA, higher-order aberrations.

Figure 1 (A–E) Case 1: 49 year old male. (A) Pre-op topography, (B) Post-op topography, (C) Pre-op OCT pachymetry and epithelial thickness map, (D) Post-op OCT pachymetry and epithelial thickness map, (E) patient data.

Figure 2 (A–E) Case 2: 32 year old male. (A) Pre-op topography, (B) Post-op topography, (C) Pre-op OCT pachymetry and epithelial thickness map, (D) Post-op OCT pachymetry and epithelial thickness map, (E) patient data.

Figure 3 (A–E) Case 3: 20 year old female: (A) Pre-op topography, (B) Post-op topography, (C) Pre-op OCT pachymetry and epithelial thickness map, (D) Post-op OCT pachymetry and epithelial thickness map, (E) patient data.