Long-term Results of Mini Asymmetric Radial Keratotomy and Corneal Cross-linking for the Treatment of Keratoconus

Abstract

Purpose To investigate the long-term results (at least 5 years of follow-up) of the mini asymmetric radial keratotomy (MARK) and corneal cross-linking (CXL) combined intervention, also known as the ‘Rome protocol,’ for patients with progressive stage I and II keratoconus and contact lens intolerance. Methods This was a retrospective observational case series. Fifteen eyes of 12 patients were evaluated, with a mean follow-up of 6.9 years. To assess the efficacy and stability of the MARK + CXL combined protocol, best spectacle-corrected visual acuity, mean pachymetry, and mean keratometry were recorded preoperatively and at least 1, 3, and 5 years postoperatively. Statistical analysis was performed using the R platform and involved the Wilcoxon signed-rank and Kruskal-Wallis non-parametric tests. Results Best spectacle-corrected visual acuity improved for all patients, from 0.46 ± 0.69 logarithm of the minimum angle of resolution (20 / 60) to 0.15 ± 0.69 logarithm of the minimum angle of resolution (20 / 30, p = 0.0006), while mean pachymetry increased in 93% of patients, from 442.80 ± 61.02 to 464.50 ± 62.72 µm ( p = 0.003). Lastly, mean keratometry improved in 87% of patients after 6.9 years of observation from 48.82 ± 5.00 to 43.25 ± 3.58 diopters ( p = 0.008). No intraoperative or postoperative complications were observed. Conclusions The MARK + CXL combined protocol was effective in treating keratoconus by halting corneal thinning and bulging. In addition, this procedure significantly improved visual acuity based on long-term follow-up data. Analysis of data from a larger cohort of patients would be useful to support these findings.

Safety of transglutaminase-induced corneal collagen cross-linking on the central cornea thickness and intraocular pressure in vivo

“…2 In treating progressive keratoconus, corneal CXL has become the gold standard because it strengthens the corneal structure, preventing ectasia. 10 Currently, riboflavin and ultraviolet-A (UVA) are used in conventional CXL. However, the CXL method using riboflavin and UVA is considered to cause discomfort to patients due to the UVA rays.…”

Long-term Results of Mini Asymmetric Radial Keratotomy for the Treatment of Keratoconus

“…The former includes penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK), 3 while the latter includes corneal cross-linking (CXL), 4 the gold standard method for Kc treatment, intracorneal ring segments (IcRS), 5 circular keratotomy (CKt), 6 mini asymmetric radial keratotomy (MARK), 7 radial/miniradial keratotomy (RK/Mini-RK), 8,9 and conductive keratoplasty (CKp). 10 Further, there is a more recent trend involving CXL paired with other procedures (CXL Plus), specifically with photorefractive keratectomy (PRK) (Athens Protocol), 11 Laser in-situ keratomileusis (LASIK), 12 ICrS, 13 MARK (Rome Protocol), 14 CKp, 15 and phakic intraocular lenses (PIoL). 16 However, despite its simplicity and effectiveness in halting Kc, CXL does not improve vision, apart from a slight degree of corneal regularisation with epithelium removal, 17 a condition that justifies the rationale behind the other procedures mentioned above.…”