@article{2998221,
    title = "Combined transepithelial phototherapeutic keratectomy and conventional photorefractive keratectomy followed simultaneously by corneal crosslinking for keratoconus: Cretan protocol plus",
    author = "Grentzelos, M.A. and Kounis, G.A. and Diakonis, V.F. and Siganos, C.S. and Tsilimbaris, M.K. and Pallikaris, I.G. and Kymionis, G.D.",
    journal = "Journal of Cataract and Refractive Surgery",
    year = "2017",
    volume = "43",
    number = "10",
    pages = "1257-1262",
    publisher = "ELSEVIER SCIENCE INC 360 PARK AVE SOUTH, NEW YORK, NY 10010-1710 USA",
    doi = "10.1016/j.jcrs.2017.06.047",
    keywords = "adult;  Article;  cell density;  clinical article;  clinical evaluation;  clinical protocol;  cornea epithelium;  cornea surgery;  corneal crosslinking;  corrected distance visual acuity;  endothelial cell density;  endothelium cell;  female;  follow up;  Greece;  human;  keratectomy;  keratoconus;  keratometry;  male;  outcome assessment;  photorefractive keratectomy;  postoperative period;  preoperative period;  priority journal;  prospective study;  transepithelial phototherapeutic keratectomy;  uncorrected distance visual acuity;  visual acuity;  excimer laser;  eye refraction;  keratectomy;  keratoconus;  multimodality cancer therapy;  procedures, cross linking reagent;  riboflavin, Combined Modality Therapy;  Corneal Topography;  Cross-Linking Reagents;  Humans;  Keratectomy;  Keratoconus;  Lasers, Excimer;  Photorefractive Keratectomy;  Prospective Studies;  Refraction, Ocular;  Riboflavin;  Visual Acuity",
    abstract = "Purpose To evaluate the visual, refractive, and topographic outcomes after combined transepithelial phototherapeutic keratectomy (PTK) and conventional photorefractive keratectomy (PRK) followed simultaneously by corneal crosslinking (CXL) for keratoconus. Setting Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece. Design Prospective case series. Methods Patients with progressive keratoconus had simultaneous conventional PRK followed by CXL; the corneal epithelium was removed using transepithelial PTK (Cretan protocol plus). The visual, refractive, and topographic outcomes and the endothelial cell density (ECD) were evaluated preoperatively and 1, 3, 6, and 12 months postoperatively. Results Forty-three patients (55 eyes) were enrolled. The mean uncorrected and corrected distance visual acuities improved significantly from 0.98 ± 0.63 (SD) logarithm of minimum angle of resolution (logMAR) and 0.20 ± 0.23 logMAR preoperatively to 0.39 ± 0.35 logMAR (P <.001) and 0.08 ± 0.16 logMAR (P <.001) 12 months postoperatively, respectively. The mean spherical equivalent improved significantly from −4.67 ± 4.00 diopters (D) preoperatively to −2.24 ± 2.81 D (P <.001) at 12 months. The mean steep keratometry (K) and flat keratometry readings decreased significantly from 50.30 ± 5.00 D and 45.62 ± 3.10 D preoperatively to 46.27 ± 3.90 D (P <.001) and 43.46 ± 3.00 D (P <.001) 12 months postoperatively, respectively. No ECD alterations were observed throughout the follow-up (P >.05). Conclusion Combined transepithelial PTK and conventional PRK followed simultaneously by CXL was effective in corneal stabilization and vision improvement in keratoconic patients. © 2017 ASCRS and ESCRS"
}