Three-Year Outcomes of Cross-Linking PLUS (Combined Cross-Linking with Femtosecond Laser Intracorneal Ring Segments Implantation) for Management of Keratoconus

Iqbal, Mohammed; Elzembely, Hosam; Elagouz, Mohammed; Saeed, Ahmed; Mohammed, Osama Ali; Kamel, Ahmed Gad

doi:10.1155/2018/6907573

Cited by 24 publications

(30 citation statements)

References 18 publications

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“…Many studies reported KC progression following initial SCXL treatment 34,35. The failure rates ranged from 0%12 to 16.5% 36. While the recorded postoperative period for documentation of KC progression following SCXL varied from early postoperative months34 to several postoperative years32,35 and even reached 10 years in Raiskup et al37 Our study recorded 4.1% failure rate at 5 years which is similar to some studies38 and lower than others 34,36…”

Section: Discussionsupporting

confidence: 84%

“…In comparison with other CXL protocols, SCXL has greater improvements in KC indices 9. Despite the superiority of SCXL in comparison with transepithelial CXL in halting KC progression,10,11 the combination procedures; sometimes called cross-linking plus (CXL Plus);12,13 have become popular procedures that include combination of CXL with a refractive procedure such as wavefront-guided photorefractive keratectomy (WFG PRK),14 refractive lens surgery (RLS)15 and intracorneal ring segments (ICRS) to correct the refractive status of the ectatic eyes 12,16…”

Section: Introductionmentioning

confidence: 99%

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<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

Iqbal¹,

Elmassry²,

Badawi³

et al. 2019

OPTH

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PurposeTo analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management.Patients and methodsThis study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively.ResultsForty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by <1 D, 23 eyes (46.9%) improved from 1 D to <2 D and 7 eyes (14.3%) improved by ≥2 D. Both uncorrected distant visual acuity (UDVA) and corrected distant visual acuity (CDVA) showed statistically significant improvement from preoperative 1.34±0.29 (mean±SD) and 0.74±0.23 LogMAR to postoperative 0.99±0.32 and 0.50±0.22 LogMAR (P<0.0001) respectively. Both Kmax and SE refraction showed statistically significant and stable improvement from preoperative 51.95±1.90 and −7.90±3.14 D to postoperative 50.19±1.96 and −6.35±2.49 D (P<0.0001) respectively. Two eyes (4%) showed KC progression at the end of 5th follow-up year.ConclusionSCXL had good effectiveness and stability that halted KC progression over 5-year follow-up period. It had also unexpected improvement in the KC refractive components mainly the spherical and SE components.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

Iqbal¹,

Elmassry²,

Badawi³

et al. 2019

OPTH

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“…Fifteen years ago, standard corneal cross-linking (CXL) was introduced as a successful treatment for the stop of corneal ectasia in progressive keratoconus by Wollensak et al (2003) in Dresden, Germany. In the meantime, accelerated epithelium-off cross-linking (AXL) to reduce the treatment time has been developed and its combination with refractive procedures such as PRK and intracorneal ring segments (ICRS) to also reduce the refractive error of keratoconus has been promoted (Kanellopoulos & Binder 2007;Kanellopoulos 2009;Kanellopoulos & Asimellis 2014;Kymionis et al 2014;Saleem et al 2018). This combination is sometimes called cross-linking plus (CXL-Plus).…”

Section: Introductionmentioning

confidence: 99%

Standard cross‐linking versus photorefractive keratectomy combined with accelerated cross‐linking for keratoconus management: a comparative study

Iqbal

Elmassry

Tawfik

et al. 2018

Acta Ophthalmologica

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Purpose To compare the safety and efficacy of standard 30 min epithelium‐off cross‐linking ( CXL ) versus photorefractive keratectomy ( PRK ) combined with accelerated epithelium‐off cross‐linking ( AXL ) for the treatment of progressive keratoconus ( CXL ‐Plus). Methods This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL . Group B included 67 eyes treated with combined PRK and AXL . The recorded data included UDVA , CDVA , subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow‐up. Results In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (Log MAR ± SD ). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (Log MAR ± SD ). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D. Conclusion Surprisingly, standard CXL showed close results to CXL ‐Plus at the 24th follow‐up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL ‐Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long‐term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL .

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“…CXL is a relatively new technique used for the stabilization of ectatic disorders [13, 14]. The technique is based on the absorption of UVA radiation by the cornea after the riboflavin is taken in absorbed by the stroma.…”

Section: Discussionmentioning

confidence: 99%

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

Weiyan

Wang

Zhang

et al. 2019

Journal of Ophthalmology

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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.

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Three-Year Outcomes of Cross-Linking PLUS (Combined Cross-Linking with Femtosecond Laser Intracorneal Ring Segments Implantation) for Management of Keratoconus

Cited by 24 publications

References 18 publications

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

<p>Visual and Refractive Long-Term Outcomes Following Standard Cross-Linking in Progressive Keratoconus Management</p>

Standard cross‐linking versus photorefractive keratectomy combined with accelerated cross‐linking for keratoconus management: a comparative study

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

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