Corneal cross-linking (CXL) combined with refractive surgery for the comprehensive management of keratoconus: CXL plus

Kankariya, Vardhaman P.; Dube, Ankita B; Grentzelos, Michael A.; Kontadakis, George A.; Diakonis, Vasilios F.; Petrelli, Myrsini; Kymionis, George D.

doi:10.4103/ijo.ijo_1841_20

Cited by 25 publications

(35 citation statements)

References 98 publications

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“…1 shows that the improvement was more pronounced after CXL plus than after CXL only. This is consistent with the assumption of a further improvement of visual function by additional refractive therapy [1].…”

Section: Discussionsupporting

confidence: 90%

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A Clinical Decision Tree to Support Keratoconus Patients Considering Corneal Cross-Linking Combined with Refractive Treatment

Iselin

Bachmann

Baenninger

et al. 2023

Klin Monbl Augenheilkd

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Background To develop a fast and frugal decision tree to identify keratoconus patients most likely to benefit visually from the combination of corneal cross-linking (CXL) with topography-guided photorefractive keratectomy (“CXL plus”). Patients and Methods The outcome of interest was an improvement in uncorrected distance visual acuity (UDVA) by at least two lines at the 12-month follow-up. Preoperative and 12-month follow-up data from patients who received CXL plus (n = 96) and CXL only (n = 96) were used in a recursive partitioning approach to construct a frugal tree with three variables (corneal thickness [>/< 430 um], patient interest in CXL plus [yes/no], and tomographic cylinder [</> 3 D]). In addition, we estimated the probability of the outcome from a multivariate logistic regression model for each combination of variables used in the decision tree. Results In the complete sample, 101/192 (52.6%) patients improved by at least two lines at the 12-month follow-up. Patients affirmative in all three answers had a 75.6% (34/45) probability of gaining at least two lines of improvement in UDVA by CXL plus. The statistical model estimated a 66.0% probability for a successful outcome. Conclusion A fast and frugal tree consisting of three variables can be used to select a patient group with a high likelihood to benefit from CXL plus. The tree is useful in the preoperative counseling of keratoconus patients contemplating the CXL plus option, an intervention that is not fully covered by many health insurances.

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Section: Discussionsupporting

confidence: 90%

“…Visual and topographic outcomes can be further improved by combining CXL with simultaneous photorefractive keratectomy (PRK) to reshape the apex. This is also termed "CXL plus", i.e., ectasia management plus refractive treatment [1]. A current review suggests that CXL plus is an effective and safe treatment modality [2].…”

Section: Introductionmentioning

confidence: 99%

A Clinical Decision Tree to Support Keratoconus Patients Considering Corneal Cross-Linking Combined with Refractive Treatment

Iselin

Bachmann

Baenninger

et al. 2023

Klin Monbl Augenheilkd

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“…Epi-on CXL, the use of Meran riboflavin, and applying the accelerated irradiation protocol appeared to be associated with reduced efficacy regarding controlling keratoconus progression, with one-third of cases treated using epi-on CXL required re-treatment. Corneal cross-linking has also been used successfully in combination with corneal ring segments and other surgical techniques [366][367][368][369][370][371]. 9.3.1.2.…”

Section: Severe Keratoconusmentioning

confidence: 99%

Keratoconus: An updated review

Santodomingo-Rubido

Carracedo

Suzaki

et al. 2022

Contact Lens and Anterior Eye

328

204

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Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20-to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal crosslinking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.

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“…Several other studies have shown the efficacy of topo-guided and wavefront-guided PRK with CXL. 7,8,[17][18][19][20][21][22][23] In this article, we present the 3-year results of simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus) in keratoconic patients. All evaluated parameters-UDVA, CDVA, SEQ, and mean (steep and flat) K values-showed significant improvement from the first postoperative year which remained stable throughout the 3-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Combinations of CXL with various refractive techniques including topography-guided, wavefront-guided, and conventional photorefractive keratectomy (PRK); transepithelial phototherapeutic keratectomy (t-PTK); intrastromal corneal ring segments (ICRS) and phakic intraocular lens (PIOL) implantation; and multiple combined techniques have been suggested. 7,8 In a previous study, we reported the 1-year results of simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus) showing significant visual improvement in patients with progressive keratoconus. 9 In this study, we present the 3-year visual, refractive, and topographic results of this combined approach in patients with progressive keratoconus.…”

mentioning

confidence: 99%

Three-Year Results of Simultaneous Transepithelial Phototherapeutic Keratectomy and Conventional Photorefractive Keratectomy (Cretan Protocol Plus) Followed by Corneal Crosslinking for Keratoconus

Grentzelos

Liakopoulos

Kankariya

et al. 2022

Cornea

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Purpose:The aim of this study was to present the 3-year outcomes after simultaneous transepithelial phototherapeutic keratectomy (t-PTK) and conventional photorefractive keratectomy (PRK) followed by corneal crosslinking (CXL) for keratoconus.Methods:In this prospective, interventional case series, patients with progressive keratoconus underwent simultaneous t-PTK and conventional PRK followed by CXL (Cretan protocol plus). Visual, refractive, and topographic outcomes were evaluated along with endothelial cell density (ECD) preoperatively and at 1, 2, and 3 years postoperatively.Results:Twenty-two patients (31 eyes) were enrolled. No intraoperative or postoperative complications were observed in any of the patients. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected and mean corrected distance visual acuity improved from 0.81 ± 0.40 and 0.18 ± 0.21 preoperatively to 0.38 ± 0.33 (P < 0.001) and 0.06 ± 0.12 (P < 0.001) at 3-year follow-up. Mean spherical equivalent improved from −5.39 ± 3.89 diopters (D) preoperatively to −2.29 ± 2.65 D (P < 0.001) at 3 years postoperatively. Mean corneal astigmatism reduced from −4.70 ± 2.86 D preoperatively to −3.55 ± 2.45 D (P = 0.001) at 3 years postoperatively. No ECD alterations were observed throughout the 3-year follow-up (P > 0.05).Conclusions:Simultaneous t-PTK and conventional PRK followed by CXL seems to be an effective and safe treatment for progressive keratoconus over 3-year follow-up.

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Corneal cross-linking (CXL) combined with refractive surgery for the comprehensive management of keratoconus: CXL plus

Cited by 25 publications

References 98 publications

A Clinical Decision Tree to Support Keratoconus Patients Considering Corneal Cross-Linking Combined with Refractive Treatment

A Clinical Decision Tree to Support Keratoconus Patients Considering Corneal Cross-Linking Combined with Refractive Treatment

Keratoconus: An updated review

Three-Year Results of Simultaneous Transepithelial Phototherapeutic Keratectomy and Conventional Photorefractive Keratectomy (Cretan Protocol Plus) Followed by Corneal Crosslinking for Keratoconus

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