@article{3122702,
    title = "Long-term Comparison of Combined t-PTK and CXL (Cretan Protocol) Versus CXL with Mechanical Epithelial Debridement for Keratoconus",
    author = "Grentzelos, M.A. and Liakopoulos, D.A. and Siganos, C.S. and Tsilimbaris, M.K. and Pallikaris, I.G. and Kymionis, G.D.",
    journal = "Journal of Refractive Surgery",
    year = "2019",
    volume = "35",
    number = "10",
    pages = "650-655",
    publisher = "SLACK Incorporated",
    issn = "1081-597X",
    doi = "10.3928/1081597X-20190917-01",
    keywords = "dexamethasone plus tobramycin;  fluorometholone;  collagen;  cross linking reagent;  photosensitizing agent, adult;  Article;  astigmatism;  clinical article;  comparative effectiveness;  cornea surgery;  cornea thickness;  corneal cross linking;  debridement;  eye refraction;  female;  follow up;  human;  keratectomy;  keratoconus;  keratometry;  male;  postoperative period;  preoperative period;  priority journal;  prospective study;  transepithelial phototherapeutic keratectomy;  treatment outcome;  vision;  visual acuity;  comparative study;  cornea epithelium;  cornea stroma;  debridement;  excimer laser;  keratoconus;  metabolism;  multimodality cancer therapy;  photochemotherapy;  photorefractive keratectomy;  physiology;  procedures;  ultraviolet radiation;  young adult, Adult;  Collagen;  Combined Modality Therapy;  Corneal Stroma;  Corneal Topography;  Cross-Linking Reagents;  Debridement;  Epithelium, Corneal;  Female;  Follow-Up Studies;  Humans;  Keratoconus;  Lasers, Excimer;  Male;  Photochemotherapy;  Photorefractive Keratectomy;  Photosensitizing Agents;  Prospective Studies;  Refraction, Ocular;  Ultraviolet Rays;  Visual Acuity;  Young Adult",
    abstract = "PURPOSE: To compare the long-term outcomes of corneal cross-linking (CXL) for the treatment of keratoconus using two different techniques for epithelial removal: transepithelial phototherapeutic keratectomy (t-PTK) and mechanical epithelial debridement. METHODS: In this prospective, comparative, interventional case series, 26 patients (30 eyes) with progressive keratoconus underwent CXL treatment. Fifteen eyes (13 patients) underwent epithelial removal with t-PTK (Cretan protocol) and 15 eyes (13 patients) underwent mechanical epithelial debridement (Dresden protocol) during CXL. Visual, refractive, and keratometric outcomes were evaluated preoperatively and at 1, 2, 3, and 4 years postoperatively. RESULTS: No intraoperative or postoperative complications were observed in any of the patients. In the Cretan protocol group, mean uncorrected (UDVA) and corrected (CDVA) visual acuity improved from 0.99 ± 0.42 and 0.33 ± 0.28 logMAR preoperatively to 0.75 ± 0.32 (P = .018) and 0.21 ± 0.16 (P = .024) logMAR at 4 years postoperatively, respectively. In the Dresden protocol group, mean UDVA improved from 0.83 ± 0.47 logMAR preoperatively to 0.63 ± 0.40 logMAR (P = .033) at 4 years postoperatively, whereas mean CDVA did not demonstrate a statistically significant improvement postoperatively (P > .05). In the Cretan protocol group, mean corneal astigmatism improved from -6.19 ± 4.54 diopters (D) preoperatively to -4.68 ± 3.10 D (P = .041) at last follow-up, whereas in the Dresden protocol group there was no statistically significant difference postoperatively (P > .05). CONCLUSIONS: Epithelial removal with t-PTK during CXL (Cretan protocol) resulted in better visual, refractive, and keratometric outcomes compared with mechanical epithelial debridement over a long-term follow-up. Copyright © SLACK Incorporated."
}