Combined photorefractive keratectomy and corneal collagen cross-linking for treatment of keratoconus: a 2-year follow-up study

Rosa, Giuseppe De; Rossi, Silvia; Santamaria, Carmine; Boccia, Rosa; Rosa, Luigi De; D'Alterio, Francesco Maria; Simonelli, Francesca

doi:10.1177/25158414221083362

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…De Rosa et al applied topography-guided PRK (WaveLight ALLEGRETTO WAVE® Eye-Q, ALCON, Fort Worth, TX, USA), followed by standard CXL in stages 1–2 KC (K1 45.18 ± 2.17, and K2 48.79 ± 3.22), correcting 40% of the myopic refractive error (3.65 ± 2.01 D) and 70% of the cylinder (3.63 ± 1.67 D) respecting a maximal ablation depth of 50 µm, reporting safety and efficacy with 24-months refractive stability [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Intraocular pressure after combined photorefractive keratectomy and corneal collagen cross-linking for keratoconus

Nabil,

Elmassry,

Ntakarusho

et al. 2023

Int Ophthalmol

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Purpose The purpose of this prospective study was to evaluate the effect of combined photorefractive keratectomy (PRK) and corneal collagen cross-linking (CXL) on intraocular pressure (IOP) in patients with keratoconus (KC). Methods We included 64 eyes of 34 patients (19 males and 15 females; age: 19-40y) with stages 1–2 keratoconus which had undergone combined wavefront-optimized photorefractive keratectomy and corneal collagen cross linking. Two other groups of patients were added as controls: the PRK group including 110 eyes of 57 patients (23 males and 34 females; age: 18-44y) which had undergone wavefront-optimized photorefractive keratectomy for myopic refractive errors, and the CXL group including 36 eyes of 23 patients (14 males and 9 females; age: 12-38y) with keratoconus, not filling the inclusion criteria for combined PRK and CXL, which had undergone corneal collagen cross-linking. IOP was recorded preoperatively and postoperatively at 3, 6 and 12 months follow-up visits. Results Preoperative IOP in both CXL (12.1 ± 2.53 mmHg) and PRK + CXL (13.2 ± 2.50 mmHg) groups was significantly lower than PRK group (15.8 ± 3.10 mmHg) (F = 30.505, p < 0.001). At 3 months postoperatively, IOP showed no statistically significant difference between the three studied groups (F = 1.821, p = 0.164). At 6 months postoperatively, IOP in the CXL group (14.6 ± 2.64 mmHg) was significantly higher than both PRK (13.4 ± 2.27 mmHg) and PRK + CXL (13.3 ± 2.62 mmHg) groups (F = 3.721, p = 0.026). At 12 months postoperatively, IOP in the CXL group (14.3 ± 2.69 mmHg) was significantly higher than the PRK group (13.2 ± 2.23 mmHg) and was higher than PRK + CXL group (13.3 ± 2.59 mmHg) although not statistically significant (F = 3.393, p = 0.035). Regarding the percent of change from preoperative IOP, a statistically significant difference between the three studied groups was detected at 3, 6 and 12 months postoperatively (H = 117.459, 109.303, 122.694 respectively, p < 0.001). The median percent of change from preoperative IOP in the PRK group was −16.7%, −15%, and −16.7%, in the CXL group was + 14.3%, + 19.4%, and + 19.1%, while in PRK + CXL group was 0% at 3, 6 and 12 months postoperatively. (Post-hoc power analysis 75%). Conclusions Combined PRK and CXL in patients with KC shows no significant effect on IOP, in contrast to either procedure performed separately.

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Section: Discussionmentioning

confidence: 99%

Intraocular pressure after combined photorefractive keratectomy and corneal collagen cross-linking for keratoconus

Nabil,

Elmassry,

Ntakarusho

et al. 2023

Int Ophthalmol

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“…7). 1,3,[44][45][46][47][48][49] Across these papers, 473 eyes were included, with an average follow-up period of 20 months. With respect to UDVA and CDVA, there were improvements of 20.47 6 1.53 logMAR (CD 0.31; P ,0.001) and 20.22 6 2.29 logMAR (CD 0.11; P = 0.11), respectively, with K1 and K2 values also improving by 1.54 6 1.00 D (CD 1.55; P ,0.001) and 2.93 6 1.17 D (CD 2.50; P ,0.001), respectively.…”

Section: Topography-guided Prk and CXLmentioning

confidence: 99%

Merging PRK and Collagen Crosslinking: An Analysis of Literature and a Guide to Prevalent Protocols

Moshirfar,

Rognon,

Olson

et al. 2024

Cornea

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Purpose: The purpose of this review was to summarize the different surgical approaches combining photorefractive keratectomy (PRK) and corneal crosslinking (CXL), present each protocol template in a simple format, and provide an overview of the primary outcomes and adverse events. Methods: A literature review was conducted as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eight different databases were searched. Papers were included if PRK was immediately followed by CXL. Results: Thirty-seven papers met the inclusion criteria of a total yield of 823. The latest research into simultaneous PRK and CXL has been shown to not only stabilize the cornea and prevent keratoconus progression but also improve the visual acuity of the patient. Improvements in uncorrected distance visual acuity and (spectacle) corrected distance visual acuity were found to be significant when considering all protocols. There were also significant reductions in K1, K2, mean K, Kmax, sphere, cylinder, and spherical equivalent. Random-effects analysis confirmed these trends. Corrected distance visual acuity was found to improve by an average of 0.18 ± 1.49 logMAR (Cohen's D [CD] 0.12; P <0.02). There was also a significant reduction of 2.57 ± 0.45 D (CD 5.74; P <0.001) in Kmax. Cylinder and spherical equivalent were also reduced by 1.36 ± 0.26 D (CD 5.25; P <0.001) and 2.61 ± 0.38 D (CD 6.73; P <0.001), respectively. Conclusions: Combining the 2 procedures appears to be of net benefit, showing stabilization and improvement of ectatic disease, while also providing modest gains in visual acuity. Since customized PRK and CXL approaches appear superior, a combination of these would likely be best for patients.

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“…In these cases, combined procedures may represent an option to provide these patients with the greatest visual potential bilaterally. The combination of cross-linking with a refractive operation (either two or three procedures such as photorefractive keratectomy 17 , 18 with mitomycin-C applications, 19 phakic intraocular lenses (pIOLs), 20 , 21 or intracorneal ring segment implantation) called ‘corneal cross-linking Plus’ halt keratoconus development while also correcting refractive error. 22 …”

Section: Introductionmentioning

confidence: 99%

Keratoconus: exploring fundamentals and future perspectives – a comprehensive systematic review

Niazi,

Gatzioufas,

Doroodgar

et al. 2024

Ophthalmol Eye Dis

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Background: New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way. Objectives: This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies. Design: A multidimensional comprehensive systematic narrative review. Data sources and methods: A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed. Results: Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes. Conclusion: The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients. Trial registration: The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338

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Combined photorefractive keratectomy and corneal collagen cross-linking for treatment of keratoconus: a 2-year follow-up study

Cited by 4 publications

References 31 publications

Intraocular pressure after combined photorefractive keratectomy and corneal collagen cross-linking for keratoconus

Intraocular pressure after combined photorefractive keratectomy and corneal collagen cross-linking for keratoconus

Merging PRK and Collagen Crosslinking: An Analysis of Literature and a Guide to Prevalent Protocols

Keratoconus: exploring fundamentals and future perspectives – a comprehensive systematic review

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