Transcript Slide 1

LASIK Combined with Corneal Cross-linking in Eyes with
Potentially Elevated Risk of Corneal Ectasia
Michael Korchak, MD; Roxanne Littner, MS; Briana E. McFadden, MHA; MS; Tonoa Person,
COT; William Trattler, MD; Roy Rubinfeld, MD
Georgetown University
Results
Abstract
Purpose: To evaluate laser in situ keratomileusis (LASIK) with corneal
Patient Characteristics
Uncorrected Visual Acuity Outcomes
cross-linking (CXL) in eyes with potentially elevated risk of ectasia.
32 eyes of 17 patients were enrolled (11 female, 6 male)
All eyes (100%) had at least UCVA 20/40 at latest follow-up; 93.5% were
Methods: 32 eyes were prospectively studied for up to 12 months. Risk
The average age was 35.6 years (range: 19-59 years), four patients were
20/30 or better; 83.9% were 20/25 or better
factors included subtle irregular astigmatism on corneal imaging,
between 18-25 years of age
In patients with 12 month follow-up, 81.3% (13/16) eyes had UCVA 20/25
12 patients had high myopia, four patients had subtle irregular
or better with one eye 20/30 and two eyes 20/40
astigmatism, and one patient had prior RK with hyperopic shift
No enhancements were performed in this study group
corneal thickness <500µm, age 18-25 years, or high myopia (>7
diopters (D)).
Results: Mean LogMAR uncorrected visual acuity (UCVA) improved
Sixteen eyes had full 12-month follow-up, eight eyes had follow-up through
from 1.39 to 0.10 (n=32) at one month, 0.08 (n=24) at six months, and
the 6-month visit, and eight eyes were lost to follow-up after 1-month
0.08 (n=16) at one year. All eyes (100%) had at least UCVA 20/40 at
latest follow-up; 93.5% were 20/30 or better; 83.9% were 20/25 or
LASIK CXL UCVA
1.6
Pre-operative Assessment
better. No enhancements were performed. Mean manifest spherical
1.4
26/32 eyes had UCVA of 20/800
refractive equivalent (MRSE) improved from -6.38D to -0.125D (n=16)
n=32
Mean refraction: -7.11D SPH (-11.5D to +1.5D) + 1.46D CYL (0 to +5.5D)
at one year.
Conclusion: LASIK with CXL may permit safer vision correction in
Mean MRSE: -6.38D (range: -11.125D to +2.75D)
patients considered borderline candidates.
24/32 eyes had high refractive error (greater than -7D)
13/32 eyes had cylinder greater than +1.5D
LogMAR UCVA
1.2
0.8
0.6
0.4
Mean Baseline CCT: 531.9µm (range: 489–616)
Introduction
1
0.2
Eight eyes had CCT of 500µm or less
n=24
0
Pre op
n=32
n=24
1 month
3 months
6 months
n=16
12 months
Corneal ectasia is an uncommon, but potentially severe and dreaded
Post-operative Results
complication of LASIK
Mean MRSE improved to -0.074 (n=32) at 1 month, -0.115 (n=24) at 6
Fig 1. Mean LogMAR uncorrected visual acuity outcomes with sample size
Some patients are thought to have an increased risk of corneal ectasia, for
months, and -0.125 (n=16) at 12 months
shown for each data point. Mean LogMAR uncorrected visual acuity (UCVA)
example patients with forme fruste keratoconus, high myopia, or younger
No eyes lost two or more lines of BSCVA
improved from 1.39 preoperatively to 0.10 at one month, 0.14 at three
age
CXL is thought to augment the tectonic strength of the cornea by using UVA
No patients developed corneal ectasia
months, 0.08 at six months, and 0.08 at one year. Eight eyes were lost after
the 1-month visit; all had UCVA 20/25 or better with 5/8 with UCVA: 20/20.
light and the photo-mediator riboflavin
CXL has been shown to safely strengthen corneas in conditions such as
Conclusions
keratoconus, pellucid marginal degeneration, and post-LASIK ectasia
We examined the safety and biomechanical stability of patients undergoing
 In eyes with theoretical increased risk for
corneal ectasia, LASIK with CXL appears to
be safe and effective
 This combination may permit patients
previously considered borderline candidates
for LASIK to be treated more safely
LASIK combined CXL in patients with a theoretical increased risk for corneal
ectasia
Methods
Corneal Cross-linking with UVA light application
Patients with risk factors for corneal ectasia were enrolled in this
Discussion
nonrandomized, prospective study
All patients received LASIK with CXL, using a proprietary CXL system
Risk
factors:
some
subtle
degree
of
irregular
astigmatism
on
topography/tomography, corneal thickness of 500 µm or less, age 18-25
Early results suggest LASIK with CXL appears to be safe and effective in
patients with a theoretical increased risk for corneal ectasia
years, or high myopia (greater than 7 diopters)
This combined procedure may allow for LASIK to be performed more
Visual and refractive outcomes as well as keratometric and topographic
safely in patients considered to be borderline candidates
measurements were evaluated preoperatively and at 1, 3, 6, and 12 months
Further studies are needed to further establish the safety and efficacy of
postoperatively
this combination, such as a randomized control trial comparing LASIK to
Patients with incomplete follow-up were analyzed up to the last study visit
LASIK with CXL in borderline candidates
References
1.
Cheema AS, Mozayan A, Channa P. Corneal collagen crosslinking in refractive surgery. Curr Opin Ophthalmol.
2012 Jul;23(4):251-6.
2.
Kanellopoulos AJ1, Kahn J. Topography-guided hyperopic LASIK with and without high irradiance collagen
cross-linking: initial comparative clinical findings in a contralateral eye study of 34 consecutive patients. J
Refract Surg. 2012 Nov;28(11 Suppl):S837-40.
3.
Richoz O, Mavrakanas N, Pajic B, Hafezi F. Corneal collagen cross-linking for ectasia after LASIK and
photorefractive keratectomy: long-term results. Ophthalmology. 2013 Jul;120(7):1354-9
Financial Disclosures
Roy Rubinfeld has financial interests in CXLUSA and CXLO. William Trattler has financial interests in CXLO
And is a consultant for CXLUSA.
Poster produced by Faculty & Curriculum Support (FACS), Georgetown University School of Medicine