Central corneal regularization (CCR): an alternative approach in keratoconus treatment

Background:To evaluate the safety and efficacy of an approach that combines corneal customized transepithelial therapeutic ablation to treat irregular corneal optics and accelerated corneal collagen cross-linking(CXL)to strengthen the corneal tissue and stop the progression of keratoconus.The transepithelial therapeutic ablation applied a novel concept named central corneal regularization(CCR)which could correct the corneal morphological irregularities and the eye’s spherocylindrical refractive error with minimal stromal tissue removal.Methods:Retrospective study.Eyes that underwent CCR combined with CXL were evaluated preoperatively and up to 12 months postoperatively for visual acuity,subjective refraction,corneal haze,pachymetry and maximum keratometry(Kmax).Results:Twenty four eyes of 24 patients with a mean age of 28.92±9.88 years were treated.The mean spherical equivalent(SE)refractive error changed from−0.74±1.17 D preoperatively to−1.05±1.52 D at 12 months postoperatively.The mean uncorrected distance visual acuity(UDVA)and corrected distance visual acuity(CDVA)improved.No eye lost lines of CDVA,21 had a mean improvement of 3.21 lines.The mean cylinder error and Kmax value dropped from−3.06±1.83 D and 51.38±3.29 D to−1.04±0.80 D and 48.70±2.58 D,respectively.The mean haze score at 3,6 and 12 months was 0.56,0.19 and 0.06,respectively.Conclusions:CCR combined with CXL offers promising results as a safe and effective treatment in keratoconic patients.