Corneal collagen crosslinking in refractive surgery

Cheema, Anjum; Mozayan, Arash; Channa, Prabjot

doi:10.1097/icu.0b013e3283543cbd

Cited by 31 publications

(8 citation statements)

References 57 publications

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“…Excimer laser treatment shows promising results (Cheema et al 2012;Kremer et al 2012), and implantation of intrastromal ring segments is also beneficial (Coskunseven et al 2009), although the contribution of crosslinking to the summarized effect may not have been fully elucidated (Cakir et al 2013). In thermokeratoplasty (Kymionis et al 2010) or microwave treatment (Vega-Estrada et al 2012), the corneal stiffening effect from CXL, using the current treatment regimen, is insufficient to maintain the initial corneal flattening and significant regression occurs.…”

Section: Discussionmentioning

confidence: 99%

Initial results from mechanical compression of the cornea during crosslinking for keratoconus

Rehnman

Behndig

Hallberg

et al. 2014

Acta Ophthalmologica

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ABSTRACT.Purpose: To compare refractive changes after corneal crosslinking with and without mechanical compression of the cornea. Methods: In a prospective, open, randomized case-control study conducted at the Department of Ophthalmology, Ume a University Hospital, Sweden, sixty eyes of 43 patients with progressive keratoconus aged 18-28 years planned for corneal crosslinking and corresponding age-and sex-matched control subjects were included. The patients were randomized to conventional corneal crosslinking (CXL; n = 30) or corneal crosslinking with mechanical compression using a flat rigid contact lens sutured to the cornea during treatment (CRXL; n = 30). Subjective refraction and ETDRS best spectacle-corrected visual acuity (BSCVA), axial length measurement, keratometry and pachymetry were performed before and 1 and 6 months after treatment. Results: The keratoconus patients had poorer BSCVA, higher refractive astigmatism and higher keratometry readings than the control subjects at baseline (p < 0.01). In the CXL group, BSCVA increased from 0.19 AE 0.26 to 0.14 AE 0.18 logMar (p = 0.03), and the spherical equivalent improved from À1.9 AE 2.8 D to À1.4 AE 2.4 D (p = 0.03). Maximum keratometry readings decreased after CXL from 53.1 AE 4.9 D to 52.6 AE 5.2 D (p = 0.02), and the axial length decreased in the CXL group, likely due to post-treatment corneal thinning (p = 0.03). In the CRXL group, all the above variables were unaltered (p > 0.05). Conclusion: At 6 months, the refractive results from CRXL did not surpass those of conventional CXL treatment. Rather, some variables indicated a slightly inferior effect. Possibly, stronger crosslinking would be necessary to stabilize the cornea in the flattened configuration achieved by the rigid contact lens.

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Section: Discussionmentioning

confidence: 99%

Initial results from mechanical compression of the cornea during crosslinking for keratoconus

Rehnman

Behndig

Hallberg

et al. 2014

Acta Ophthalmologica

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“…Collagen cross‐linking (CXL) is an effective method in halting or stopping the progression of keratoconus and corneal ectasia (Cheema et al. ; Xu et al. ; Bikbova & Bikbov ).…”

Section: Introductionmentioning

confidence: 99%

Combined application of prophylactic corneal cross‐linking and laser in‐situ keratomileusis – a review of literature

Chan

et al. 2016

Acta Ophthalmologica

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Laser in-situ keratomileusis (LASIK) is safe and effective laser refractive procedures in treating refractive errors. However, regression of treatment and iatrogenic keratectasia remain to be a major concern, especially in treating thin cornea with high ametropia. Collagen cross-linking (CXL) is an effective method in stopping keratoconus progression through increasing the biomechanical strength of the cornea. Adjuvant cross-linking to refractive procedures can theoretically help prevent regression and reduce the risk of keratectasia development by increasing the mechanical stability of cornea. During the procedure, riboflavin is directly applied to the corneal stroma, thereby reducing the need of de-epithelialization as in the conventional protocol for keratoconus. Currently, there is still no consensus regarding the indication of CXL during refractive procedure, nor any standardized treatment protocol. This article aims to summarize the current evidence regarding the use of adjuvant CXL in LASIK.

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“…Corneal topography should be examined carefully prior to the procedure for any signs of abnormality that may suggest a tendency to developing corneal ectasias such as keratoconus; if any are found, LASIK is not recommended. Additionally, since keratoconus often manifests in the teens to 20s, younger patients are at higher risk for ectasia as they may have an underlying tendency that has not yet manifested (Randleman 2006;Cheema et al 2012).…”

Section: Post-lasik Ectasiamentioning

confidence: 99%