Comparison of accelerated CXL alone, accelerated CXL-ICRS, and accelerated CXL-TG-PRK in progressive keratoconus and other corneal ectasias.

Abstract

PURPOSE:

To compare accelerated corneal crosslinking (CXL) alone, CXL with simultaneous intrastromal corneal ring segments (CXL-ICRS), and CXL with simultaneous topography-guided photorefractive keratectomy (CXL-TG-PRK) in progressive keratoconus, pellucid marginal degeneration (PMD), or laser in situ keratomileusis (LASIK)-induced ectasia.

SETTING:

The Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada.

DESIGN:

Prospective nonrandomized interventional study.

METHODS:

Visual and topographical outcomes using a comparative analysis adjusting for preoperative maximum keratometry (Kmax) were evaluated 1 year postoperatively.

RESULTS:

Four hundred fifty-two eyes from 375 patients with progressive keratoconus, PMD, or LASIK-induced ectasia that underwent accelerated (9 mW/cm, 10 minutes) CXL alone (n = 204), CXL-ICRS (n = 126), or CXL-TG-PRK (n = 122) were included. Change in logarithm of the minimum angle of resolution uncorrected distance visual acuity was significant with CXL-ICRS (-0.31; 95% CI, -0.38 to -0.24) and CXL-TG-PRK (-0.16; 95% CI, -0.24 to -0.09), but not with CXL alone. No significant differences in change were found between the 3 groups. Change in corrected distance visual acuity (CDVA) was significant in all 3 groups: -0.12 (95% CI, -0.15 to -0.10) with CXL alone, -0.23 (95% CI, -0.27 to -0.20) with CXL-ICRS, and -0.17 (95% CI, -0.21 to -0.13) with CXL-TG-PRK. Improvement in CDVA was greater with CXL-ICRS than with CXL alone (-0.08 ± 0.02; P < .0001) and CXL-TG-PRK (-0.05 ± 0.02; P = .005). Change in Kmax was significant with CXL-ICRS [-3.21 diopters (D); 95% CI, -3.98 to -2.45] and CXL-TG-PRK (-3.69 D; 95% CI, -4.49 to -2.90), but not with CXL alone (-0.05 D; 95% CI, -0.66 to 0.55).

CONCLUSIONS:

CXL alone might be best for keratoconic patients who meet the inclusion criteria. CXL-ICRS might be more effective for eyes with more irregular astigmatism and worse CDVA and CXL-TG-PRK for eyes requiring improvements in irregular astigmatism but still have good CDVA.

• Authors: Neera Singal, Stephan Ong Tone, Raymond Stein, Matthew C Bujak, Clara C Chan, Hall F Chew, Sherif El-Defrawy, Yaping Jin, Christoph Kranemann, Theodore Rabinovitch, David S Rootman, Allan R Slomovic, Ashley Cohen, David Dai, Wendy Hatch
• Journal: Journal of cataract and refractive surgery (J Cataract Refract Surg) Vol. 46 Issue 2 Pg. 276-286 (02 2020) ISSN: 1873-4502 [Electronic] United States
• PMID: 32126042 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cross-Linking Reagents
• Photosensitizing Agents
• Collagen
• Riboflavin

Topics

• Adult
• Collagen (metabolism)
• Corneal Stroma (metabolism, surgery)
• Corneal Topography
• Cross-Linking Reagents
• Dilatation, Pathologic (therapy)
• Female
• Humans
• Keratoconus (drug therapy, physiopathology, surgery, therapy)
• Lasers, Excimer (therapeutic use)
• Male
• Photorefractive Keratectomy (methods)
• Photosensitizing Agents (therapeutic use)
• Prognosis
• Prospective Studies
• Prostheses and Implants
• Prosthesis Implantation
• Refraction, Ocular (physiology)
• Riboflavin (therapeutic use)
• Surgery, Computer-Assisted
• Surveys and Questionnaires
• Ultraviolet Rays
• Visual Acuity (physiology)
• Young Adult