Management of Corneal Ectasia after LASIK with Phototherapeutic Keratectomy Combined with Photorefractive Keratectomy and Collagen Cross-Linking

Abstract

Background. To evaluate the efficacy of phototherapeutic keratectomy (PTK) combined with photorefractive keratectomy (PRK) and riboflavin with ultraviolet-A collagen cross-linking (CXL), performed sequentially on the same day, in the management of corneal ectasia after LASIK. Methods. This retrospective review comprised consecutive patients with corneal ectasia after LASIK. The patients were administered PTK and PRK on the previous corneal flap, and CXL was given on the same day by the same surgeon. The main outcome measures included age, sex, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent refraction, cylinder equivalent refraction, steep and flat keratometries (K), central corneal thickness (CCT), endothelial cell count, corneal haze, and ectasia stability. Mean follow-up period was 6, 12, and 24 months. Results. Sixteen eyes of twelve patients were included in the study. Twenty-four months after administration of PTK combined with PRK and CXL, a significant improvement in UDVA was observed. Mean cylinder equivalent refraction was significantly reduced at 6, 12, and 24 months postoperatively. However, no significant reduction was observed in spherical equivalent refraction. A significant reduction in the flat K and steep K values was observed. No significant change in mean CCT value was observed. Mean endothelial cell count and morphology were unchanged between preoperative and postoperative patients. In addition, no obvious corneal haze was observed. Conclusions. PTK combined with PRK and CXL on the same day is a safe and effective treatment in improving visual acuity in selected patients with corneal ectasia after LASIK.

Comprehensive management of post‐LASIK ectasia: From prevention to treatment

“…Although many studies have demonstrated that CXL can stop the progression of the cone, improve corneal curvature and maintain BCVA over time, most patients still require refractive correction to achieve visual rehabilitation. A large number of studies have focused on combining CXL with other refractive surgeries such as PRK, LASIK, Intra‐Corneal Ring Segments (ICRS) and Phakic intraocular lenses(pIOLs), which is termed CXL plus, for the purpose of enhancing the efficacy of CXL (El‐Khoury et al, 2018; Kamburoglu & Ertan, 2008; Tamayo et al, 2017; Yildirim, Cakir, et al, 2014; Yildirim, Uslu, et al, 2014; Zhou et al, 2019).…”

Tel-Aviv Protocol for Postrefractive Surgery Corneal Ectasia: A Case Series

“…It reduces irregular astigmatism and refractive error, improving visual outcomes without compromising the efficacy of CXL in keratoconus 21 and post-LASIK ectasia. 22,23 In 2019, Kaiserman et al proposed the Tel-Aviv Protocol, which recommended a combination of epithelial photorefractive keratectomy (ePRK) combined with CXL for treating keratoconus. This protocol involves removing the epithelium using a customized refractive laser profile, followed by laser ablation using the EX500 excimer laser.…”

“…It reduces irregular astigmatism and refractive error, improving visual outcomes without compromising the efficacy of CXL in keratoconus 21 and post-LASIK ectasia. 22,23…”