Simultaneous Topography-guided Custom Ablation With Corneal Cross-linking for Keratoconus: 10-Year Prospective Outcomes

PURPOSE: To assess 10-year visual and tomographic out-comes of topography-guided custom ablation (T-CAT) with corneal cross-linking (CXL) in eyes with keratoconus. METHODS: T-CAT with CXL was performed in 600 eyes (522 patients). Based on the T-CAT ablation plan, the theoretical maximum ablation depth was 50 mu m after epithelium remov-al. After ablation, accelerated corneal cross-linking (CXL) was performed in the central 8-mm zone (9 mW/cm2 for 10 minutes in "epi-off" mode). The visual acuity and tomography were assessed.RESULTS: There was significant improvement in uncorrected (P = .001) and corrected (P = .001) distance visual acuity after the procedure. Keratometry, root mean square lower order aberrations and higher order aberrations, defocus, coma 90(degrees), and spherical aberration reduced significantly after surgery at 10 years of follow-up (P < .005). All Pentacam (Oculus Op-tikgerate GmbH) tomographic variables showed significant changes indicating regularization after T-CAT (P < .005). Flat-tening of greater than 5.00 diopters in maximum keratometry was noted in 6 eyes (1%). Two of 600 eyes progressed postop-eratively and required repeat CXL.CONCLUSIONS: T-CAT plus CXL is a safe and effective tech-nique even in the long term for regularizing the anterior cor-neal surface with significant visual improvement and reduc-tion in higher order corneal aberrations.