Epithelial photorefractive keratectomy vs mechanical epithelial removal followed by corneal crosslinking for keratoconus: The Tel-Aviv Protocol

Purpose:To compare the Tel-Aviv Protocol, epithelial photorefractive keratectomy (ePRK) combined with corneal crosslinking (CXL), to CXL with alcohol-assisted epithelial removal (Alc-CXL) for progressive keratoconus.Setting:Care-Vision Laser Centers, Tel Aviv, Israel.Design:Retrospective study.Methods:All patients underwent Alc-CXL or ePRK, a 50 m laser ablation of the epithelium with a myopic spherical component and an astigmatic component, followed by CXL. All patients completed at least 1 year of follow-up.Results:A total of 131 eyes of 131 patients were included in the study. Fifty patients (38%) were included in the Tel-Aviv Protocol group, and 81 patients (62%) were included in the Alc-CXL group. There was a significant improvement in uncorrected distance visual acuity (UDVA) (from 1.22 ± 0.75 logarithm of the minimum angle of resolution [logMAR] to 0.49 ± 0.44 logMAR, P <.001), corrected distance visual acuity (CDVA) (from 0.29 ± 0.17 logMAR to 0.16 ± 0.12 logMAR, P <.001), Kmax (from 48.50 ± 3.00 diopters [D] to 46.50 ± 3.00 D, P <.001), and cylinder (from-3.31 ± 1.70 D to-2.32 ± 1.66 D, P <.001) in the Tel-Aviv Protocol group in comparison with nonsignificant changes in the Alc-CXL group in UDVA (from 0.89 ± 0.62 logMAR to 0.81 ± 0.65 logMAR, P =.23), CDVA (from 0.25 ± 0.21 logMAR to 0.21 ± 0.17 logMAR, P =.10), Kmax (from 46.50 ± 4.50 D to 46.00 ± 4.40 D, P =.08), and cylinder (from-2.99 ± 2.05 D to-2.80 ± 1.75 D, P =.39) at the end of the follow-up period.Conclusions:The Tel-Aviv Protocol for progressive keratoconus patients provided good improvement in visual acuity and astigmatism while halting the progression of keratoconus.