Topo-guided removal of epithelium in keratoconus (TREK) is a new technique for managing keratoconus, comprising topography-guided removal of epithelium with minimal stromal ablation. For 352 eyes, ablation depth of 20 microns beyond the thinnest epithelial thickness was applied over the highest steepening using the PTK-CAM module of the Schwind Amaris system, performing a single-step transphototherapeutic keratectomy. This was followed by manual removal of surrounding epithelium over a 7-mm area and an accelerated collagen crosslinking. Two years postoperatively, the spherical equivalent (SEQ), maximal anterior curvature (Kmax), and root mean square of higher-order aberrations (RMS) decreased in conjunction with a significant improvement in visual acuity. TREK is a safe and effective novel tissue-sparing treatment that regularizes thin corneas, advanced keratoconus, and decentered cones.

Financial Disclosures: Drs. Pooja Khamar and Rohit Shetty disclose no financial relationships.