Simultaneous Accelerated Corneal Crosslinking and Laser In situ Keratomileusis for the Treatment of High Myopia in Asian Eyes

Low, Jin Rong; Lim, Louis W.; Koh, Jane Chwee Wah; Chua, Daniel; Rosman, Mohamad

doi:10.2174/1874364101812010143

Cited by 14 publications

(12 citation statements)

References 23 publications

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“…No severe intra- or postoperative complications have been observed in any studies, although some have reported mild haze [ 8 , 13 , 15 , 16 , 23 , 24 ], diffuse lamellar keratitis [ 13 , 16 , 24 ] and epithelial erosions [ 16 ], which disappeared from 1 day to 12 months after surgery. The intra- or intergroup ECC was not significantly different throughout the follow-up period [ 9 , 10 , 13 , 14 , 17 , 24 ]. In line with previous studies, we found no severe adverse events in the LASIK Xtra group.…”

Section: Discussionmentioning

confidence: 99%

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A prospective randomized self-controlled study of LASIK combined with accelerated cross-linking for high myopia in Chinese: 24-month follow-up

et al. 2022

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Background To assess the visual and refractive outcomes of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) concurrent with accelerated cross-linking (LASIK Xtra) compared with conventional FS-LASIK (convLASIK) for high myopia in Chinese individuals. Methods In this prospective, randomized, fellow-eye comparison study, 25 patients with high myopia were treated randomly with LASIK Xtra in one eye and convLASIK in the other. A 24-month follow-up was conducted, and the main outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE) and corneal tomography. Results The UDVA was 0.09 ± 0.15 logMAR in the LASIK Xtra group, which was significantly worse than that in the convLASIK group 1 day postoperatively (P = .001), but the difference became nonsignificant from 1 week after surgery. The efficacy index was 0.88 ± 0.18 in the LASIK Xtra eyes and 0.99 ± 0.13 in the convLASIK eyes at 24 months (P = .028). Throughout the follow-up period, a slight myopic shift in the MRSE and keratometry values were observed in both groups without significant intergroup differences. The coefficient of determination was 0.9982 in the LASIK Xtra eyes and 0.9987 in the convLASIK eyes. The corneal density was significantly higher, and demarcation lines were visible in the first 6 months in LASIK Xtra eyes, but both signs of cross-linking gradually disappeared during follow-up. No severe complications were detected in either group. Conclusions LASIK Xtra showed comparable safety and predictability with convLASIK for high myopia in Chinese, but lower efficacy and no greater stability was observed up to 24-month follow-up.

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Section: Discussionmentioning

confidence: 99%

“…In general, LASIK with and without CXL both achieved good predictability with a strong correlation between the attempted and achieved MRSE. Low J.R [ 13 ]. reported that 72% of eyes achieved an MRSE within ± 0.50 D in the LASIK Xtra group and 84% in the convLASIK group at the 3-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

A prospective randomized self-controlled study of LASIK combined with accelerated cross-linking for high myopia in Chinese: 24-month follow-up

et al. 2022

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“… 40 , 41 For LASIK Xtra, however, total UV energy exposure varies from as low as 1.4J/cm 2 to as high as 5.4J/cm2. 14 , 19 , 42 Since CXL is used as a form of prophylaxis in LASIK Xtra rather than therapeutic treatment, most studies use a lower total UV energy exposure as compared to keratoconus treatment. Our study demonstrates that although a lower UVA energy of 1.4 J/cm 2 (UVA fluence of 30 mW/cm 2 , 46 seconds duration) was utilized compared with the other LASIK Xtra studies with >1 year follow-up with UVA energy utilization ranging from 1.8–5.4J/cm 2 , it had similar refractive stability and reduced myopic regression to the other studies.…”

Section: Discussionmentioning

confidence: 99%

<p>Three-Year Outcomes of Simultaneous Accelerated Corneal Crosslinking and Femto-LASIK for the Treatment of High Myopia in Asian Eyes</p>

Lim¹,

Lim²,

Rosman³

et al. 2020

OPTH

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To determine the long-term visual outcomes of simultaneous femtosecond laserassisted laser in situ keratomileusis (femto-LASIK) and accelerated cross-linking (CXL) [LASIK Xtra] for the treatment of high myopia. Patients and Methods: All 163 consecutive eyes of 85 patients who underwent LASIK Xtra for the treatment of high myopia and/or myopic astigmatism (spherical equivalent ≥ −6.00 D) in Singapore National Eye Centre from the years 2013 to 2017 were included in this retrospective case series. Post-operative follow-up was up to 3 years. Results: Of the 163 eyes, 67 were followed up for 1 year (mean 12.9 months), 69 for 2 years (mean 24.0 months) and 43 for 3 years (mean 36.4 months). Overall mean follow-up was 22.8 months (9-46 months). The mean pre-operative spherical equivalent (SE) was −8.60 ± 1.47 D [range: −11.75 to −4.75] (n = 163) and mean attempted correction SE was −8.84 ± 1.41 D [range: −11.88 to −5.25]. Most eyes (>95%) maintained an uncorrected distance visual acuity of 6/12 or better over 3 years. Visual outcomes were predictable with ≥95% of eyes achieving a SE correction within ± 1D of attempted correction over 3 years. There was a mild regression in SE refraction over 3 years with a mean of −0.10 ± 0.45 D three years post-operatively (p = 0.03). The safety index was >1.05 at 3 years follow-up. There were no significant post-operative complications though 24 eyes had mild haze and 2 eyes had grade 1 diffuse lamellar keratitis that resolved within 1 month. Conclusion: Our 3-year LASIK Xtra results show favorable safety, efficacy, predictability and stability outcomes in Asian patients with high myopia.

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“…However, many refractive surgeons are reserved to combine corneal refractive procedures with cross-linking due to reasons such as potential risk of haze, overcorrection, or hyperopic outcome due to progressive flattening as a result of cross-linking, additional cost, and lack of knowledge and experience, etc. However, evidence is growing that a refractive surgery with simultaneous cross-linking is safe and effective in preventing ectasia without any significant side effects [24][25][26][27][28]. Especially, when combined with SMILE, it was shown to be beneficial in preventing ectasia when used to treat borderline corneas [29].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Long-Term Outcomes and Refractive Stability following SMILE versus SMILE Combined with Accelerated Cross-Linking (SMILE XTRA)

Brar

Sriganesh

Sute

et al. 2022

Journal of Ophthalmology

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Purpose. To compare the long-term safety, efficacy, predictability, and refractive stability following SMILE versus SMILE combined with accelerated cross-linking (SMILE XTRA), and to specifically study the regression patterns following the two procedures. Methods. This retrospective study included 54 eyes of SMILE and 54 eyes of SMILE XTRA treated for normal and borderline cases of myopia/myopic astigmatism, respectively, based on certain predefined topographic features and risk factors. Patients in both the groups were matched for age and refractive error. The mean postoperative follow-up for the SMILE group was 22.18 ± 10.41 months and the SMILE XTRA group was 21.81 ± 10.19 months. Results. At the end of follow-up, the mean sphere, cylinder, and SE reduced to −0.03, −0.09, and −0.08 D in the SMILE group and −0.06, −0.15, and −0.13 D in the SMILE XTRA group. 96% and 93% eyes remained within ±0.50 D in SMILE and SMILE XTRA groups, respectively, and 94% eyes maintained an UDVA of 20/20 or better in the SMILE as well as SMILE XTRA groups. Safety and efficacy indices for the SMILE group were 1.03 and 1.00. For the SMILE XTRA group, the safety and efficacy indices were 1.00 and 0.99. No eye in either group had postoperative ectasia or enhancement performed for significant residual refractive error. Conclusion. Both the SMILE and SMILE XTRA groups exhibited comparable visual outcomes, safety, and efficacy. Contrary to the belief, combination of prophylactic CXL with SMILE did not result in a hyperopic shift in the long term. No eye in either group encountered postoperative ectasia; however, further follow-up is suggested to establish the long-term effects on refractive and corneal stability following SMILE XTRA, as all the eyes treated in this group were borderline.

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Simultaneous Accelerated Corneal Crosslinking and Laser In situ Keratomileusis for the Treatment of High Myopia in Asian Eyes

Cited by 14 publications

References 23 publications

A prospective randomized self-controlled study of LASIK combined with accelerated cross-linking for high myopia in Chinese: 24-month follow-up

A prospective randomized self-controlled study of LASIK combined with accelerated cross-linking for high myopia in Chinese: 24-month follow-up

<p>Three-Year Outcomes of Simultaneous Accelerated Corneal Crosslinking and Femto-LASIK for the Treatment of High Myopia in Asian Eyes</p>

Comparison of Long-Term Outcomes and Refractive Stability following SMILE versus SMILE Combined with Accelerated Cross-Linking (SMILE XTRA)

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