Staff Members - Benha University
Standard cross-linking versus photorefractive keratectomy combined with accelerated cross-linking for keratoconus management: a comparative study
• 2018
Publication Information
Authors
Mohammed Iqbal,1 Ahmed Elmassry,2 Ahmed Tawfik,3 Mervat Elgharieb,4 Khaled Nagy,5
Ashraf Soliman,6 Hisham Saad,5 Tarek Tawfik,7 Osama Ali,1 Ahmed Gad,1 Islam El Saman,1
Alaa Radwan,8 Hosam Elzembely,9 Amin Abou Ali1 and Omar Fawzy10
Keywords
CXL-Plus – ectasia – epithelium-off CXL – keratoconus – PRK – standard CXL
Journal
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Publisher
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Volume
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Issue
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Pages
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publication.type
International
Paper Link
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Supplementary Materials
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Abstract
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 (LogMARSD). 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
(LogMAR 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.
StandardCXLseems to be more powerful thanAXLin its long-term effect. Therefore, in the
future, we want to test the combination of PRK with standard CXL.
(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 (LogMARSD). 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
(LogMAR 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.
StandardCXLseems to be more powerful thanAXLin its long-term effect. Therefore, in the
future, we want to test the combination of PRK with standard CXL.