Safety and Efficacy of Consecutive LASIK and Accelerated Corneal CXL: Prospective Analysis
Narrative Responses:
Purpose
Regression and post LASIK ectasia are potential consequences of biomechanical weakening of the cornea induced by LASIK. This paper presents the preliminary outcomes of an evaluation of the safety and efficacy of accelerated corneal cross-linking treatment for the stabilization of the cornea after LASIK (Lasik Xtra) in four treatment groups.
Methods
A prospective study of Lasik Xtra was conducted for four treatment groups: Myopes (group 1, n=57 eyes), Hyperopes (group 2, n=16 eyes), Myopic Presbyopes (LBV)( group 3, n=13 eyes) and Hyperopic Presbyopes (group 4, n=10 eyes). LASIK was performed on groups 1 and 2, Laser Blended Vision (LBV) was performed on groups 3 and 4. In all eyes, VibeX Xtra (0.25% Riboflavin, AVEDRO), was applied to the stromal bed after excimer ablation and soaked for 90 seconds while the flap was left open. The bed was rinsed and the flap repositioned. 45mW/cm2 irradiance was applied for 90 seconds (KXL, Avedro).
Results
Visual function and slitlamp biomicroscopy were obtained preoperatively and compared to 1 day, 1 and 3 month postoperative outcomes in each group. Mean preoperative BCVA were 1.00, 0.96, 0.99, and 1.00 in groups 1,2,3 and 4 respectively. At 1 month, UCVA and BCVA were 0.81 and 0.95 respectively in group 1; 0.88 and 0.95 in group 2; 0.82 and 1.02 in group 3 and 0.68 and 0.98 in group 4. By 3 months, the initial worsening of BCVA was reversed, returning to a mean 1.00 in all measured groups. A transient postoperative haze was observed, resolving by 3 months.
Conclusion
Lasik Xtra was safe, with no lasting reduction in BCVA. Transient postoperative haze, similar to that seen in conventional cross-linking was observed. After resolution of the haze, Lasik Xtra resulted in smooth, clear flaps and excellent visual acuity in all treatment groups. Longer term results are needed to demonstrate stability.