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Combined Corneal Cross-Linking and Photoablation for KC-Risks of

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Controversies in the Management of Keratoconus

Abstract

Traditionally, keratoconus (KC) with a pre-existing structural weakness is a contraindication for photoablative procedures. At the present time, corneal collagen crosslinking (CXL) is an accepted treatment to stop progression of KC. It is well documented that CXL significantly increases the rigidity of the KC cornea [1]. The idea of combined CXL and photoablation is based on the ability of CXL to increase the corneal rigidity, while photoablation of limited amount of tissue in KC cornea can safely improve the visual function and comfort. This assumption is correct if a standardized CXL procedure can produce predictable corneal biomechanical changes with constant and permanent biomechanical stability of the KC eye.

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References

  1. Wollensak G. Crosslinking treatment of progressive keratoconus: new hope. Curr Opin Ophthalmol. 2006;17:356–60.

    Article  Google Scholar 

  2. Ziaei M, et al. Reshaping procedures for the surgical management of corneal ectasia. J Cataract Refract Surg. 2015;41:842–72.

    Article  Google Scholar 

  3. Hersh PS, et al. United States multicenter clinical trial of corneal crosslinking for keratoconus treatment. Ophthalmology. 2017;124:1259–70.

    Article  Google Scholar 

  4. Greenstein SA, et al. Cornea topography indices after corneal collagen crosslinking for keratoconus and corneal ectasia: one year results. J Cataract Refract Surg. 2011;37:1282–90.

    Article  Google Scholar 

  5. Randleman JB, et al. Corneal crosslinking. Surv Ophthalmol. 2015;60:509–23.

    Article  Google Scholar 

  6. Chatzis N, Hafezi F. Progression of keratoconus and efficacy of pediatric[corrected] corneal collagen crosslinking in children and adolescents. J Refract Surg. 2011;28:753–8.

    Article  Google Scholar 

  7. Koller T, et al. Complication and failure rates after corneal crosslinking. J Cataract Refract Surg. 2009;35:1358–62.

    Article  Google Scholar 

  8. Hersh PS, et al. Corneal collagen crosslinking for keratoconus and corneal ectasia: one year results. J Cataract Refract Surg. 2011;37:149–60.

    Article  Google Scholar 

  9. Sloot F, et al. Effective corneal collagen crosslinking in advanced cases of progressive keratoconus. J Cataract Refract Surg. 2013;39:1141–5.

    Article  Google Scholar 

  10. Raiskup-Wolf F, et al. Collagen crosslinking with riboflavin and ultraviolet-a light in keratoconus: long tem result. J Cataract Refract Surg. 2008;34:796–801.

    Article  Google Scholar 

  11. Santhiago MR, Giacomin NT, Medeiros CS, et al. Intense early flattening after corneal collagen cross-linking. J Refract Surg. 2015;31:419–22.

    Article  Google Scholar 

  12. Kymionis GD, et al. Excessive corneal flattening and thinning after corneal crosslinking: single case report with 5-year follow-up. Cornea. 2015;34:704–6.

    Article  Google Scholar 

  13. Hafezi F, et al. Marked remodeling of the anterior corneal surface following cross-linking with riboflavin and UVA. Br J Ophthalmol. 2011;95:1171–2.

    Article  Google Scholar 

  14. Raiskup F, et al. Permanent corneal haze after riboflavin-UVA-induced crosslinking in keratoconus. J Refract Surg. 2009;25:S824–8.

    Article  Google Scholar 

  15. Kanellopoulos AJ, et al. Corneal collagen crosslinking [CXL] with sequential topography-guided PRK: a temporizing alternative for keratoconus to penetrating keratoplasty. Cornea. 2007;26:891–5.

    Article  Google Scholar 

  16. Kymionis GD, et al. Simultaneous topography guided PRK followed by corneal collagen crosslinking for keratoconus. JRS. 2009;25:S807–11.

    Article  Google Scholar 

  17. Kanellopoulos AJ. Comparison of sequential vs same-day simultaneous collagen crosslinking and topography guided PRK for treatment of keratoconus. JRS. 2009;25:S812–8.

    Article  Google Scholar 

  18. Labiris G, et al. Impact of keratoconus cross-linking and cross-linking combined with photorefractive keratectomy on self reported quality of life. Cornea. 2012;31:734–9.

    Article  Google Scholar 

  19. Kontadakis GA, et al. Long term comparison of simultaneous topography guided collagen photorefractive keratectomy followed by corneal cross-linking versus corneal cross-linking alone. Ophthalmology. 2016;123:974–83.

    Article  Google Scholar 

  20. Alessio G, et al. Photorefractive keratectomy followed by crosslinking versus cross-linking alone for management of progressive keratoconus: two-year follow-up. Am J Ophthalmol. 2013;155:54–65.

    Article  Google Scholar 

  21. Kymionis GD, et al. Corneal collagen crosslinking [CXL] combined with refractive procedures for the treatment of corneal ectatic disorders: CXL plus. J Refract Surg. 2014;30:566–76.

    Article  Google Scholar 

  22. Bekesi N, Gallego-Muñoz P, Ibarés-Frías L, et al. Biomechanical changes after in vivo collagen cross-linking with rose bengal-green light and riboflavin-UVA. Invest Ophthalmol Vis Sci. 2017;58:1612–20.

    Article  CAS  Google Scholar 

  23. Kymionis GD, et al. Corneal collagen crosslinking mushroom shape demarcation line profile after limited Bowman membrane removal by photorefractive keratectomy. Open Ophthalmol J. 2015;9:17–9.

    Article  Google Scholar 

  24. Kolozsva’ri L, et al. UV absorbance of the human cornea in the 240 to 400-nm range. Invest Ophthalmol Vis Sci. 2002;43:2165–8.

    Google Scholar 

  25. Guell JL, et al. Late onset of a persistent deep stromal scarring after PRK and corneal cross-linking in a patient with forme fruste keratoconus. J Refract Surg. 2014;30:286–8.

    Article  Google Scholar 

  26. Prakash G, et al. Persistent stromal scar after PRK and CXL: different preoperative findings, similar complication. J Refract Surg. 2015;31:211.

    Article  Google Scholar 

  27. Krueger RR, Kanellopoulos AJ. Stability of simultaneous topography-guided photorefractive keratectomy and riboflavin/UVA cross-linking for progressive keratoconus: case reports. J Refract Surg. 2010;26:S827–32.

    Article  Google Scholar 

  28. Kymionis GD, et al. Simultaneous topography-guided photorefractive keratectomy followed by corneal collagen cross-linking for keratoconus. Am J Ophthalmol. 2011;152:748–55.

    Article  Google Scholar 

  29. Tuwairqi WS, Sinjab MM. Safety and efficacy of simultaneous corneal collagen cross-linking with topography-guided PRKin managing low-grade keratoconus: 1-year follow-up. J Refract Surg. 2012;28:341–5.

    Article  Google Scholar 

  30. Sakla H, et al. Simultaneous topography guided partial photorefractive keratectomy and corneal collagen crosslinking for keratoconus. J Cataract Refract Surg. 2014;40:1430–8.

    Article  Google Scholar 

  31. Kanellopoulos AJ, Asimellis G. Keratoconus management: long-term stability of topography-guided normalization combined with high-fluence CXL stabilization (the Athens protocol). J Refract Surg. 2014;30:88–93.

    Article  Google Scholar 

  32. Fadlallah A, et al. Non-topography guided PRK combined with CXL for correction of refractive errors in patients with early stage keratoconus. J Refract Surg. 2014;30:688–93.

    Article  Google Scholar 

  33. Shetty R, et al. Cone location-dependent outcomes after combined topography-guided photorefractive keratectomy and collagen cross-linking. Am J Ophthalmol. 2015;159:419–25.

    Article  Google Scholar 

  34. Kanellopoulos AJ, Asimellis G. Novel placido-derived topography-guided excimer corneal normalization with cyclorotation adjustment: enhanced Athens protocol for keratoconus. J Refract Surg. 2015;31:768–73.

    Article  Google Scholar 

  35. Shaheen MS, et al. Wave front-guided photorefractive keratectomy using a high-resolution aberrometer after corneal collagen cross-linking in keratoconus. Cornea. 2016;35:946–53.

    Article  Google Scholar 

  36. Sakla H, et al. Simultaneous topography-guided photorefractive keratectomy and accelerated corneal collagen cross-linking for keratoconus. Cornea. 2016;35:941–5.

    Article  Google Scholar 

  37. Chen X, et al. Epithelial thickness profile change after combined topography guided transepithelial PRK and corneal cross-linking in treatment 634 of keratoconus. J Refract Surg. 2016;32:626.

    Article  Google Scholar 

  38. Grentzelos MA, et al. Combined transepithelial phototherapeutic keratectomy and conventional photorefractivekeratectomy followed simultaneously by corneal crosslinking for keratoconus: Cretan protocolplus. J Cataract Refract Surg. 2017;43:1257–62.

    Article  Google Scholar 

  39. Stojanovic A, et al. Topography-guided transepithelial surface ablation followed by corneal collagen crosslinking performed in a single combined procedure for the treatment of keratoconus and pellucid marginal degeneration. J Refract Surg. 2010;26:145–52.

    Article  Google Scholar 

  40. Wernli J, et al. The efficacy of corneal cross-linking shows a sudden decrease with very high intensity UV light and short treatment time. Invest Ophthalmol Vis Sci. 2013;54:1176–80.

    Article  Google Scholar 

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Correspondence to Joseph Frucht-Pery .

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Frucht-Pery, J., Wajnsztajn, D. (2019). Combined Corneal Cross-Linking and Photoablation for KC-Risks of. In: Barbara, A. (eds) Controversies in the Management of Keratoconus . Springer, Cham. https://doi.org/10.1007/978-3-319-98032-4_18

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  • DOI: https://doi.org/10.1007/978-3-319-98032-4_18

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  • Online ISBN: 978-3-319-98032-4

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