Evaluation of the Effectiveness of Cross-Linking Combined With Photorefractive Keratectomy for Treatment of Keratoconus

Overview

Journal Cornea

Specialty Ophthalmology

Date 2018 Jun 29

PMID 29952798

Citations 13

Authors

Mohammed Iqbal

Ahmed Elmassry

Ahmed Tawfik

Mervat Elshabrawy Elgharieb

Osama Mohiey El Deen Al Nahrawy

Ashraf Hassan Soliman

Hisham A Saad

Hosam A Ibrahim Elzembely

Ahmed Mohamed Saeed

Osama Ali Mohammed

Ahmed Gad Kamel

Islam Saad El Saman

Affiliations

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Abstract

Purpose: To evaluate the effectiveness and safety of combined epithelium-off cross-linking (CXL) with photorefractive keratectomy (CXL Plus) for correction of the myopic and astigmatic components of keratoconus.

Methods: Seventy-nine eyes of 46 patients who underwent CXL Plus were enrolled in this retrospective, multicenter, noncomparative clinical study. Uncorrected distance visual acuity, corrected distance visual acuity, refraction, keratometry, and pachymetry measurements were recorded preoperatively and at 3, 6, 12, and 18 months during follow-up.

Results: The mean (±SD) preoperative uncorrected distance visual acuity and corrected distance visual acuity were 1.00 ± 0.22 logarithm of the minimum angle of resolution (logMAR) and 0.62 ± 0.38 logMAR, respectively, and improved to 0.71 ± 0.36 logMAR and 0.32 ± 0.18 logMAR postoperatively. The mean k value, mean corneal thickness at the thinnest location, and mean myopic and astigmatic components decreased from 46.58 ± 0.97 D, 473 ± 29 μm, 3.65 ± 1.72 D, and 1.83 ± 0.69 D preoperatively to 43.79 ± 1.17 D, 431 ± 38 μm, 1.02 ± 0.78 D, and 1.15 ± 0.26 D, respectively, during follow-up. Eleven eyes had delayed epithelial healing, 2 had stromal opacities, 1 had primary herpes simplex keratitis, and 5 showed progression of keratoconus.

Conclusions: CXL Plus improved the refractive status of keratoconus during 18 months of follow-up, despite its potential early postoperative complications of delayed epithelial healing and corneal haze. CXL Plus reduced the myopic component more than the astigmatic component of keratoconus. However, the safety and stability of the procedure were offset by longer-term postoperative complications and a high rate of postoperative progression of keratoconus.

Citing Articles

Topography-guided photorefractive keratectomy combined with accelerated corneal collagen cross-linking versus cross-linking alone for progressive keratoconus: a long-term prospective cohort study.

Dai Z, Liu Z, Zhang Y, Yuan Y, Liu Y, Wang Y Front Med (Lausanne). 2024; 11:1420264.

PMID: 39188874 PMC: 11345261. DOI: 10.3389/fmed.2024.1420264.

Outcomes of the Q value-based nomogram in managing pediatric versus adult keratoconus: a prospective interventional study.

Iqbal M, Hammour A, Elsayed A, Gad A Med Hypothesis Discov Innov Ophthalmol. 2024; 12(2):78-89.

PMID: 38357612 PMC: 10862023. DOI: 10.51329/mehdiophthal1473.

Late-Onset Haze and Severe Corneal Flattening after Combined Corneal Collagen Cross-Linking and Photorefractive Keratectomy (CXL Plus): A Case Report.

Mazouchi M, Hassanpour K, Esfandiari H, Sadoughi M Case Rep Ophthalmol. 2024; 15(1):56-62.

PMID: 38234306 PMC: 10794048. DOI: 10.1159/000535987.

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

Nabil K, Elmassry A, Ntakarusho S, Said A Int Ophthalmol. 2023; 43(12):4837-4849.

PMID: 37861937 PMC: 10724307. DOI: 10.1007/s10792-023-02886-w.

The Safety Profile of FDA-Approved Epithelium-Off Corneal Cross-Linking in a US Community-Based Healthcare System.

Ang M, Darbinian J, Hoskins E, Holsclaw D, Sudesh S, Chandra N Clin Ophthalmol. 2022; 16:1117-1125.

PMID: 35431539 PMC: 9012302. DOI: 10.2147/OPTH.S359224.

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