Long-Term Comparison of Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Cross-linking versus Corneal Cross-linking Alone

Kontadakis, Georgios A.; Kankariya, Vardhaman P.; Tsoulnaras, Konstantinos I.; Pallikaris, Aristofanis I.; Plaka, Argyro D.; Kymionis, George D.

doi:10.1016/j.ophtha.2016.01.010

Cited by 59 publications

(64 citation statements)

References 31 publications

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“…Each group included 30 eyes that were followed up for 3 years. They used a solid state laser to achieve 50 lm ablation of the corneal stromal tissue (Kontadakis et al 2016). Our study had almost the same idea of their study; however, we used AXL instead CXL and included 125 eyes with only grade 1 keratoconus however.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Also, deeper CXL can be achieved owing to the thinner flap thickness compared to CXL alone, as CXL is known to act in the anterior 250-350 μm part of the corneal stroma [11]. A similar phenomenon was also found in a study by Kontadakis et al [20]. …”

Section: Discussionmentioning

confidence: 66%

“…Furthermore, PRK-CXL has also been demonstrated effectively in eyes with keratoconus and corneal ectasia after LASIK, such as the promising results in studies by Kymionis et al [18] and Kanellopoulos and Binder [19]. Another study by Kontadakis et al [20], which investigated tPRK-CXL for progressive keratoconus, demonstrated an improvement in UDVA of 0.56 logMAR and in CDVA of 0.17 logMAR, with the Kmean decreased by 2.63 D over 3 years.…”

Section: Discussionmentioning

confidence: 99%

Corneal Collagen Crosslinking Combined with Phototherapeutic Keratectomy and Photorefractive Keratectomy for Corneal Ectasia after Laser in situ Keratomileusis

Zhu

Han²,

Cui³

et al. 2018

Ophthalmic Res

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Purpose: The aim of this study was to analyze the effects of corneal crosslinking (CXL) combined with phototherapeutic keratectomy (PTK) and photorefractive keratectomy (PRK) in halting the progression and improving the visual function of corneal ectasia after laser in situ keratomileusis (LASIK). Methods: PTK-PRK-CXL was performed on 14 eyes of 14 patients who developed corneal ectasia after LASIK. The visual acuity, spherical refraction and cylinder, corneal topography indices, thinnest corneal thickness (TCT), and endothelial cell count were evaluated at baseline and at 1, 3, 6, and 12 months postoperatively. Results: The mean uncorrected visual acuity improved significantly from 0.64 ± 0.36 logMAR preoperatively to 0.19 ± 0.12 logMAR at 12 months of follow-up (p < 0.001), while the mean best corrected visual acuity improved from 0.21 ± 0.14 logMAR at baseline to 0.04 ± 0.10 logMAR at 12 months postoperatively (p < 0.001). A significant decrease was observed in Kmax and Kmean values from 52.51 ± 6.74 and 43.55 ± 3.37 D at baseline to 45.72 ± 5.18 (p < 0.001) and 40.60 ± 3.05 D (p < 0.001) at the 1-year follow-up. The mean TCT decreased significantly from 419.07 ± 36.56 µm before treatment to 320.93 ± 39.78 µm at 12 months of follow-up (p < 0.001), and there was no significant endothelial cell loss (p > 0.05) beyond 6 months after treatment. Conclusion: PTK-PRK-CXL is a promising procedure to halt the progression of post-LASIK keratectasia with significant visual quality improvement.

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“…We performed CXL first and PRK after 6 months, which may explain our finding of more stromal scarring. Kontadakis et al 11 performed both procedures the same day and described mild stromal scarring that became less intense and less deep with time. Sakla and Lin found that simultaneous procedures induce stromal scarring and haze more intense in the first months but virtually disappeared after 12 months 10 12…”

Section: Discussionmentioning

confidence: 99%

Two-year follow-up of corneal cross-linking and refractive surface ablation in patients with asymmetric corneal topography

et al. 2018

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Long-Term Comparison of Simultaneous Topography-Guided Photorefractive Keratectomy Followed by Corneal Cross-linking versus Corneal Cross-linking Alone

Cited by 59 publications

References 31 publications

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

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

Corneal Collagen Crosslinking Combined with Phototherapeutic Keratectomy and Photorefractive Keratectomy for Corneal Ectasia after Laser in situ Keratomileusis

Two-year follow-up of corneal cross-linking and refractive surface ablation in patients with asymmetric corneal topography

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