Corneal Collagen Crosslinking Combined with Phototherapeutic Keratectomy and Photorefractive Keratectomy for Corneal Ectasia after Laser in situ Keratomileusis

Zhu, Wei; Han, Yunfei; Cui, Changxia; Xu, Wenwen; Wang, Xuan; Dou, Xiaoxiao; Xu, Linlin; Xu, Yong; Mu, Guoying

doi:10.1159/000480242

Cited by 7 publications

(10 citation statements)

References 23 publications

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“…High pre-operative sphere, high astigmatism, corneal steepness, and older age have been well recognized to be associated with retreatment significantly [10][11][12]. Post-LASIK compensatory epithelial hyperplasia (CEH) is still a debate between researchers, and some report post-LASIK increase in CEH and causes of myopic regression [13][14][15]; however, others [12,16] did not report any correlation between CEH and regression.…”

Section: Discussionmentioning

confidence: 99%

Is the axial length a risk factor for post-LASIK myopic regression?

Gab-Alla

2020

Graefes Arch Clin Exp Ophthalmol

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Purpose To assess the relationship between the axial length and post-LASIK regression in myopic patients. Methods This is a retrospective case series study conducted at a private eye centre, Ismailia, Egypt. The clinical records of the patients, who experienced LASIK to correct myopia from January 2016 to January 2018, were analysed for myopic regression. The patients were operated on, examined, and followed-up 1 year by one surgeon (AAG). Results This study included 1219 patients (2316 eyes) with myopia. Mean ± SD of pre-operative spherical equivalent (SE) was − 4.3 ± 2.1D, range (− 0.50 to − 10.0D). Mean ± SD age of the patients was 26.4 ± 6.8 years, range (21 to 50 years). Male to female ratio was 30.5 to 69.5%. The cumulative incidence rate of myopic regression according to the medical records of the patients was 25.12% (582 eyes out of total 2316 eyes) along the 2 years of this study (12.6% per year). Of the total patients, 14.94% had pre-operative high myopia, 35.84% had pre-operative moderate myopia, and 49.2% had pre-operative low myopia. Of the patients with myopic regression, 52.6% had pre-operative high myopia, 34% had pre-operative moderate myopia, and 13.4% had pre-operative low myopia. The mean ± SD of the axial length of the patients with myopic regression was 26.6 ± 0.44 mm, range (26.0 to 27.86 mm), while the mean ± SD of the axial length of other patients with stable refraction was 24.38 ± 0.73 mm, range (22.9 to 25.9 mm) (t test statistic = 69.3; P value < 0.001). Conclusions Pre-operative high axial length increases the risk of myopic regression after LASIK.

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Section: Discussionmentioning

confidence: 99%

Is the axial length a risk factor for post-LASIK myopic regression?

Gab-Alla

2020

Graefes Arch Clin Exp Ophthalmol

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“…This small, uncontrolled case series showed significant improvements in UCVA, BCVA, keratometry, and refractive values, with acceptable safety metrics, at 1 year. A similar protocol allowing 75 μm ablation depth by PRK also showed promising early results in a small cohort of Chinese patients [60]. This particular combination may therefore be worth further exploring to determine whether there is an added benefit to laser-assisted de-epithelialization rather than mechanical debridement along with combined PRK photoablation and CXL.…”

Section: Combined CXL Procedures For Refractive Correction (Cxl Plus)mentioning

confidence: 99%

Combined Protocols for Corneal Collagen Cross-Linking with Photorefractive Surgery for Refractive Management of Keratoconus: Update on Techniques and Review of Literature

2019

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With the development and gradual dissemination of corneal collagen cross-linking (CXL) in the twenty-first century as an early treatment for keratoconus, the management paradigm has shifted to include a greater focus on complete refractive correction for these patients. Though supplemental hard contact lens therapy remains a mainstay of visual rehabilitation in keratoconus, there has been increasing appeal in a completely surgical approach by combining CXL with adjuvant refractive procedures to both halt the ectatic process and enhance functional visual outcomes. Collectively termed “CXL plus” procedures, several combined protocols have been studied to various degrees in conjunction with CXL, involving photorefractive keratectomy (PRK), transepithelial phototherapeutic keratectomy (PTK), conductive keratoplasty (CK), intrastromal corneal ring segments (ICRS) implantation, phakic intraocular lens (PIOL) implantation, or multiple of these techniques together. The scope of this review aims to encompass a summary of current CXL protocols and present the current status of studies involving adjunctive keratorefractive procedures combined with CXL. By discussing the results to date of these CXL plus protocols, we can assess what further areas of investigation are necessary within this field as the next step to optimizing treatment modalities and outcomes for our keratoconus patients, regardless of disease severity.

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“…Keratoconus is a progressive bilateral pathology of cornea, which is manifested by its thinning and protrusion that lead to astigmatism and deterioration of vision [ 1 ]. Different treatment options, such as spectacles and contact lenses [ 2 ], intrastromal corneal ring segments (ICRS) [ 3 – 7 ], keratoplasty (penetrating and deep anterior lamellar), corneal collagen cross-linking (CXL) [ 8 – 11 ] with topography-guided customized excimer laser ablation treatment—photorefractive keratectomy (PRK) [ 12 – 21 ], and combinations of the above-mentioned methods [ 16 , 21 – 23 ] with the application of novel ray-tracing excimer laser customization [ 24 ] could be used in patients with keratoconus, depending on its severity and grade. All treatment methods are reported to be effective and safe.…”

Section: Introductionmentioning

confidence: 99%

“…However, longer-term postoperative complications and a high rate of postoperative disease progression made confirmation of the safety and stability of the procedure challenging [ 12 ]. Interesting data about the clinical efficacy of the combination of ICRS with CXL in the treatment of keratoconus was presented by different researchers [ 4 – 7 , 23 ]. A more extended and detailed review of the protocols for the combined use of CXL (CXL plus) with different other treatment modalities demonstrates that further studies are required to determine the most effective treatment strategy [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…Interesting data about the clinical efficacy of the combination of ICRS with CXL in the treatment of keratoconus was presented by different researchers [ 4 – 7 , 23 ]. A more extended and detailed review of the protocols for the combined use of CXL (CXL plus) with different other treatment modalities demonstrates that further studies are required to determine the most effective treatment strategy [ 23 ]. Therefore, we decided to compare the results of different types of two-stage surgical treatment in patients with keratoconus, including combination of CXL with ICRS followed by TG-PRK.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the effectiveness of combined staged surgical treatment in patients with keratoconus

Maharramov

Aghayeva

2022

PLoS ONE

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Purpose This study performs comparative assessment of the results of different types of two-stage surgical treatment in patients with keratoconus, including combination of corneal collagen cross-linking with intrastromal corneal ring segments followed by topography-guided photorefractive keratectomy. Materials and methods Prospective review of 101 patients (101 eyes) with keratoconus was performed. Patients underwent corneal collagen cross-linking (32 patients), intrastromal corneal ring segments (48 patients), and a combination of these two procedures (21 patients). Transepithelial topography-guided photorefractive keratectomy was performed as the second stage of treatment in all patients with obtained stable refractive results at 8 months after first stage. Main outcome measures were visual acuity (uncorrected distance and corrected distance) and corneal topographic indices. Results Comparison of the studied parameters after first stage surgical treatment between non-combined CXL and combined groups demonstrated a statistically significant difference for uncorrected distance visual acuity, corrected distance visual acuity, and cylindrical refraction values (p<0.05). We observed significant improvement of visual acuity and key corneal topographic indices after topography-guided photorefractive keratectomy in all study groups (p<0.05). In 50 (49.5%) patients customized excimer laser ablation gave the possibility of full spherical and cylindrical corrections. Ten eyes (10%) had delayed epithelial healing, no corneal stromal opacities developed. Conclusions This study shows that combined two-stage surgical treatment of keratoconus, consisting of intrastromal corneal ring segment implantation with corneal collagen cross-linking followed by topography-guided photorefractive keratectomy, is clinically more effective to prevent keratectasia progression and increase visual acuity than the use of non-combined two-stage techniques.

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Corneal Collagen Crosslinking Combined with Phototherapeutic Keratectomy and Photorefractive Keratectomy for Corneal Ectasia after Laser in situ Keratomileusis

Cited by 7 publications

References 23 publications

Is the axial length a risk factor for post-LASIK myopic regression?

Is the axial length a risk factor for post-LASIK myopic regression?

Combined Protocols for Corneal Collagen Cross-Linking with Photorefractive Surgery for Refractive Management of Keratoconus: Update on Techniques and Review of Literature

Evaluation of the effectiveness of combined staged surgical treatment in patients with keratoconus

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