Precise Epithelium Removal for Ectatic Corneas Technique in Corneal Collagen Crosslinking (PERFECT-CXL): Technique Description and Clinical Outcomes.
PERFECT-CXL showed stable visual acuity in over 94% of eyes at three years, with minimal progression requiring retreatment, but further research is needed to validate these results.
Where it sits
this study against the rest of the tri-heal max protocol corpusSummary and findings
This study evaluated the clinical outcomes of the PERFECT-CXL technique for keratoconus in 362 eyes, focusing on best spectacle-corrected visual acuity (BSCVA) and maximum keratometry (Kmax) over three years. The technique involved a two-stage epithelial approach and riboflavin loading. No treatment-associated complications were reported.
Abstract
<h4>Purpose</h4>To describe clinical outcomes of a hybrid collagen crosslinking technique, Precise Epithelium Removal for Ectatic Corneas Technique Collagen Crosslinking (PERFECT-CXL) using tomography-guided hybrid partial central epithelium removal with peripheral epithelial disruption in keratoconus.<h4>Patients and methods</h4>A retrospective chart review of all previously untreated eyes that underwent PERFECT-CXL for keratoconus (KCN) by one surgeon from June 2018 to January 2023 at a single, tertiary care center. PERFECT-CXL utilizes a two-stage epithelial approach involving diffuse, across the entire cornea, roughening with an Ultracell LASIK Disc in order to create epithelial microerosions, followed by 45 minutes of loading with hypo-osmolar 0.146% riboflavin. After loading, epithelial debridement of an approximately 4-5mm zone is performed, centered over the cone, based on Pentacam tomographic localization, and the cornea is treated with pulsed UV-A irradiation. This hybrid method aims to optimize oxygen availability and targeted biomechanical stabilization while also aiming to promote faster visual recovery and an earlier return to contact lens wear. In this retrospective chart review, 362 eyes underwent PERFECT-CXL, of which 150 were previously untreated non-contact lens wearing keratoconic eyes. Outcomes measured at 6 months, 1, 2 and 3 years post-operatively included best spectacle-corrected visual acuity (BSCVA), maximum keratometry (K<sub>max</sub>), and treatment-associated complications.<h4>Results</h4>At six months, one, two, and three years post-op, BSCVA was stable in 97.5% (n = 120), 95.7% (n = 93), 94.2% (n = 69), and 94.9% (n = 39) of eyes, respectively. At one, two, and three years post-op, 80.3% (n = 117), 88.2% (n = 93), 84.1% (n = 69), and 84.6% (n = 39) of eyes experienced stabilization in K<sub>max</sub>, respectively. Of patients not lost to follow-up, 1.3% (2/150) demonstrated progression requiring retreatment within three years. There were no instances of treatment-associated complications.<h4>Conclusion</h4>Preliminary, retrospective results suggest that PERFECT-CXL can be a safe and effective technique in halting progression of KCN and can be utilized in various stages of keratoconus.
Background
The paper addresses the clinical question of optimizing corneal collagen crosslinking techniques for patients with ectatic corneas. Previous studies have highlighted the importance of epithelial removal in enhancing the effectiveness of crosslinking procedures. This study is significant as it proposes a specific technique that may improve clinical outcomes.
Methods
Not reported in abstract.
Results
Not reported in abstract.
Interpretation
Not reported in abstract.
Key findings
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Limitations
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