Outcomes of a New Microwave Procedure Followed By Accelerated Cross-linking for the Treatment of Keratoconus: A Pilot Study

Abstract

PURPOSE: To analyze the initial data obtained in a group of patients treated with microwave keratoplasty followed by accelerated corneal collagen cross-linking (CXL) for the correction of keratoconus. METHODS: Prospective, nonrandomized clinical study including six eyes from four patients treated with microwave thermal keratoplasty followed by accelerated CXL. Refractive, topographic, anterior aberrometry, and corneal biomechanics outcomes were analyzed during 6-month follow-up. RESULTS: Immediately after the procedure, a significant reduction of >7.00 diopters (D) was observed in mean keratometry (P=.02). Uncorrected distance visual acuity increased from 0.92±0.52 logMAR (Snellen 20/160) preoperatively to 0.47±0.19 logMAR (Snellen 20/60) postoperatively (P=.05). No statistically significant change was found in corrected distance visual acuity (P=.28). Corneal higher order aberration decreased from 1.89±0.90 to 1.51±0.65 μm and corneal primary coma aberration decreased from 1.45±0.68 μm preoperatively to 0.84±0.23 μm postoperatively (P>.10). No statistically significant changes were found in the biomechanics variables (P=.40). A significant regression of the effect was assessed in keratometry at the end of follow-up (P=.03). CONCLUSIONS: The Keraflex procedure may have the ability to improve refractive status in patients who suffer from keratoconus, as well as induce corneal remodeling to a more anterior regular surface. However, the current treatment regimen is not sufficient to maintain the flattening effect achieved and significant regression occurs.