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Excimer Laser and Keratoconus

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New Frontiers for the Treatment of Keratoconus

Abstract

Excimer laser is a great tool to compensate myopia, hyperopia, or astigmatism in patients with keratoconus. The indication is crucial to obtain the success of the treatment. In this chapter, the indication criteria and treatment strategies are analyzed.

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References

  1. Bardan AS, Lee H, Nanavaty MA. Outcomes of simultaneous and sequential cross-linking with excimer laser. J Refract Surg. 2018;34(10):690–6.

    Article  PubMed  Google Scholar 

  2. Müller TM, Lange AP. Topography-guided PRK and crosslinking in eyes with keratoconus and post-LASIK ectasia. Klin Monbl Augenheilkd. 2017;234(4):451–4. 28192838.

    Article  PubMed  Google Scholar 

  3. Pahuja NK, Shetty R, Sinha Roy A, Thakkar MM, Jayadev C, Nuijts RM, Nagaraja H. Laser vision correction with Q factor modification for keratoconus management. Curr Eye Res. 2017;42(4):542–8.

    Article  PubMed  Google Scholar 

  4. Fung SS, Aiello F, Maurino V. Outcomes of femtosecond laser-assisted mushroom-configuration keratoplasty in advanced keratoconus. Eye (Lond). 2016;30(4):553–61. https://doi.org/10.1038/eye.2015.273. Epub 2016 Jan 22

    Article  CAS  Google Scholar 

  5. Kanellopoulos AJ, Asimellis G. Novel placido-derived topography-guided excimer corneal normalization with cyclorotation adjustment: enhanced Athens protocol for keratoconus. J Refract Surg. 2015 Nov;31(11):768–73.

    Article  PubMed  Google Scholar 

  6. Donoso R, Díaz C, Villavicencio P. Long-term results of lasik refractive error correction after penetrating keratoplasty in patients with keratoconus. Arch Soc Esp Oftalmol. 2015;90(7):308–11.

    Article  CAS  PubMed  Google Scholar 

  7. Wu W, Wang Y, Xu L. Meta-analysis of Pentacam vs. ultrasound pachymetry in central corneal thickness measurement in normal, post-LASIK or PRK, and keratoconic or keratoconus-suspect eyes.

    Google Scholar 

  8. Kanellopoulos AJ, Asimellis G. Comparison of Placido disc and Scheimpflug image-derived topography-guided excimer laser surface normalization combined with higher fluence CXL: the Athens Protocol, in progressive keratoconus. Clin Ophthalmol. 2013;7:1385–96.

    Article  PubMed  Google Scholar 

  9. Yam JC, Cheng AC. Prognostic factors for visual outcomes after crosslinking for keratoconus and post-LASIK ectasia. Eur J Ophthalmol. 2013;23(6):799–806.

    Article  PubMed  Google Scholar 

  10. Elsahn AF, Rapuano CJ, Antunes VA, Abdalla YF, Cohen EJ. Excimer laser phototherapeutic keratectomy for keratoconus nodules. Cornea. 2009;28(2):144–7.

    Article  PubMed  Google Scholar 

  11. Tan BU, Purcell TL, Torres LF, Schanzlin DJ. New surgical approaches to the management of keratoconus and post-LASIK ectasia. Trans Am Ophthalmol Soc. 2006;104:212–20.

    PubMed  PubMed Central  Google Scholar 

  12. Binder PS, Lindstrom RL, Stulting RD, Donnenfeld E, Wu H, McDonnell P, Rabinowitz Y. Keratoconus and corneal ectasia after LASIK. J Cataract Refract Surg. 2005;31(11):2035–8. No abstract available

    Article  PubMed  Google Scholar 

  13. Kasparova EA, Kasparov AA. Six-year experience with excimer laser surgery for primary keratoconus in Russia. J Refract Surg. 2003;19(2 Suppl):S250–4.

    Article  PubMed  Google Scholar 

  14. Al-Mohaimeed MM. Combined corneal CXL and photorefractive keratectomy for treatment of keratoconus: a review. Al-Mohaimeed MM Int J Ophthalmol. 2019;12(12):1929–38.

    Article  PubMed  Google Scholar 

  15. Kymionis GD, Grentzelos MA, Voulgari N. Stromal scarring and visual acuity loss after combined PRK and CXL for keratoconus. J Refract Surg. 2019;35(6):399.

    Article  PubMed  Google Scholar 

  16. Kanellopoulos AJ. The impact of keratoconus treatment with the Athens Protocol (partial topography-guided photorefractive keratectomy combined with higher-fluence corneal collagen cross-linking) on quality of life: a long-term study. Clin Ophthalmol. 2019;13:795–803.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kanellopoulos AJ. Management of progressive keratoconus with partial topography-guided PRK combined with refractive, customized CXL – a novel technique: the enhanced Athens protocol.

    Google Scholar 

  18. Moraes RLB, Ghanem RC, Ghanem VC, Santhiago MR. Haze and visual acuity loss after sequential photorefractive keratectomy and corneal cross-linking for keratoconus. J Refract Surg. 2019;35(2):109–14.

    Article  PubMed  Google Scholar 

  19. Iqbal M, Elmassry A, Tawfik A, Elgharieb M, Nagy K, Soliman A, Saad H, Tawfik T, Ali O, Gad A, El Saman I, Radwan A, Elzembely H, Abou Ali A, Fawzy O. Standard cross-linking versus photorefractive keratectomy combined with accelerated cross-linking for keratoconus management: a comparative study. Acta Ophthalmol. 2019;97(4):e623–31.

    Article  PubMed  Google Scholar 

  20. Abou Samra W, Mokbel T, Elwan M, Saleh S, Elwehidy A, Iqbal M, Ellayeh A. Two-stage procedure in the management of selected cases of keratoconus: clear lens extraction with aspherical IOL implantation followed by WFG-PRK. Int J Ophthalmol. 2018;11(11):1761–7.

    PubMed  PubMed Central  Google Scholar 

  21. Gore DM, Leucci MT, Anand V, Fernandez-Vega Cueto L, Arba Mosquera S, Allan BD. Combined wavefront-guided transepithelial photorefractive keratectomy and corneal crosslinking for visual rehabilitation in moderate keratoconus. J Cataract Refract Surg. 2018;44(5):571–80. https://doi.org/10.1016/j.jcrs.2018.03.026.

    Article  PubMed  Google Scholar 

  22. Al-Amri AM. 5-year follow-up of combined non-topography guided photorefractive keratectomy and corneal collagen cross linking for keratoconus. Int J Ophthalmol. 2018;11(1):48–52.

    PubMed  PubMed Central  Google Scholar 

  23. Grentzelos MA, Kounis GA, Diakonis VF, Siganos CS, Tsilimbaris MK, Pallikaris IG, Kymionis GD. Combined transepithelial phototherapeutic keratectomy and conventional photorefractive keratectomy followed simultaneously by corneal crosslinking for keratoconus: cretan protocol plus. J Cataract Refract Surg. 2017;43(10):1257–62.

    Article  PubMed  Google Scholar 

  24. Müller TM, Lange AP. Topography-guided PRK and crosslinking in eyes with keratoconus and post-LASIK ectasia. Klin Monatsbl Augenheilkd. 2017;234(4):451–4.

    Article  PubMed  Google Scholar 

  25. Sakla H, Altroudi W, Munoz G, Sakla Y. Simultaneous topography-guided photorefractive keratectomy and accelerated corneal collagen cross-linking for keratoconus. Cornea. 2016;35(7):941–5.

    Article  PubMed  Google Scholar 

  26. Al-Tuwairqi WS, Osuagwu UL, Razzouk H, Ogbuehi KC. One-year clinical outcomes of a two-step surgical management for keratoconus-topography-guided photorefractive keratectomy/cross-linking after intrastromal corneal ring implantation. Eye Contact Lens. 2015;41(6):359–66.

    Article  PubMed  Google Scholar 

  27. Khakshoor H, Razavi F, Eslampour A, Omdtabrizi A. Photorefractive keratectomy in mild to moderate keratoconus: outcomes in over 40-year-old patients. Indian J Ophthalmol. 2015;63(2):157–61.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fadlallah A, Dirani A, Chelala E, Antonios R, Cherfan G, Jarade E. Non-topography-guided PRK combined with CXL for the correction of refractive errors in patients with early stage keratoconus. J Refract Surg. 2014;30(10):688–93.

    Article  PubMed  Google Scholar 

  29. Sakla H, Altroudi W, Muñoz G, Albarrán-Diego C. Simultaneous topography-guided partial photorefractive keratectomy and corneal collagen crosslinking for keratoconus. J Cataract Refract Surg. 2014;40(9):1430–8.

    Article  PubMed  Google Scholar 

  30. Dirani A, Fadlallah A, Syed ZA, Chelala E, Khoueir Z, Cherfan G, Jarade E. Non-topography-guided photorefractive keratectomy for the correction of residual mild refractive errors after ICRS implantation and CXL in keratoconus. J Refract Surg. 2014;30(4):266–71.

    Article  PubMed  Google Scholar 

  31. Wu W, Wang Y, Xu L. Meta-analysis of Pentacam vs. ultrasound pachymetry in central corneal thickness measurement in normal, post-LASIK or PRK, and keratoconic or keratoconus-suspect eyes. Graefes Arch Clin Exp Ophthalmol. 2014;252(1):91–9.

    Article  PubMed  Google Scholar 

  32. Alessio G, L’abbate M, Sborgia C, La Tegola MG. Photorefractive keratectomy followed by cross-linking versus cross-linking alone for management of progressive keratoconus: two-year follow-up. Am J Ophthalmol. 2013;155(1):54–65.e1.

    Article  PubMed  Google Scholar 

  33. Kremer I, Aizenman I, Lichter H, Shayer S, Levinger S. Simultaneous wavefront-guided photorefractive keratectomy and corneal collagen crosslinking after intrastromal corneal ring segment implantation for keratoconus. J Cataract Refract Surg. 2012;38(10):1802–7.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  35. Iovieno A, Légaré ME, Rootman DB, Yeung SN, Kim P, Rootman DS. Intracorneal ring segments implantation followed by same-day photorefractive keratectomy and corneal collagen cross-linking in keratoconus. J Refract Surg. 2011;27(12):915–8.

    Article  PubMed  Google Scholar 

  36. Spadea L. Collagen crosslinking for ectasia following PRK performed in excimer laser-assisted keratoplasty for keratoconus. Eur J Ophthalmol. 2012;22(2):274–7.

    Article  PubMed  Google Scholar 

  37. Koh IH, Seo KY, Park SB, Yang H, Kim I, Kim JS, Hwang DG, Nam SM. One-year efficacy and safety of combined photorefractive keratectomy and accelerated corneal collagen cross-linking after intacs SK intracorneal ring segment implantation in moderate keratoconus. Biomed Res Int. 2019;2019:7850216.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Rocha G, Ibrahim T, Gulliver E, Lewis K. Combined phototherapeutic keratectomy, intracorneal ring segment implantation, and corneal collagen cross-linking in keratoconus management. Cornea. 2019;38(10):1233–8.

    Article  PubMed  Google Scholar 

  39. Ahmet S, Ağca A, Yaşa D, Koç AA, Toğaç M, Yıldırım Y, Yıldız BK, Demirok A. Simultaneous transepithelial topography-guided photorefractive keratectomy and accelerated cross-linking in keratoconus: 2-year follow-up. Biomed Res Int. 2018;2018:2945751.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Sarac O, Kosekahya P, Caglayan M, Tanriverdi B, Taslipinar Uzel AG, Cagil N. Mechanical versus transepithelial phototherapeutic keratectomy epithelial removal followed by accelerated corneal crosslinking for pediatric keratoconus: long-term results. J Cataract Refract Surg. 2018;44(7):827–35.

    Article  PubMed  Google Scholar 

  41. Iqbal M, Elmassry A, Tawfik A, Elgharieb ME, El Deen Al Nahrawy OM, Soliman AH, Saad HA, Ibrahim Elzembely HA, Saeed AM, Mohammed OA, Kamel AG, El Saman IS. Evaluation of the effectiveness of cross-linking combined with photorefractive keratectomy for treatment of keratoconus. Cornea. 2018;37(9):1143–50.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Coskunseven E, Sharma DP, Grentzelos MA, Sahin O, Kymionis GD, Pallikaris I. Four-stage procedure for keratoconus: ICRS implantation, corneal cross-linking, toric phakic intraocular lens implantation, and topography-guided photorefractive keratectomy. J Refract Surg. 2017;33(10):683–9.

    Article  PubMed  Google Scholar 

  43. Chen X, Stojanovic A, Wang X, Liang J, Hu D, Utheim TP. Epithelial thickness profile change after combined topography-guided transepithelial photorefractive keratectomy and corneal cross-linking in treatment of keratoconus. J Refract Surg. 2016;32(9):626–34.

    Article  PubMed  Google Scholar 

  44. Shaheen MS, Shalaby Bardan A, Piñero DP, Ezzeldin H, El-Kateb M, Helaly H, Khalifa MA. Wave front-guided photorefractive keratectomy using a high-resolution aberrometer after corneal collagen cross-linking in keratoconus. Cornea. 2016;35(7):946–53.

    Article  PubMed  Google Scholar 

  45. Sherif AM, Ammar MA, Mostafa YS, Gamal Eldin SA, Osman AA. One-year results of simultaneous topography-guided photorefractive keratectomy and corneal collagen cross-linking in keratoconus utilizing a modern ablation software. J Ophthalmol. 2015;2015:321953.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Customized PRK performed in a keratoconic cornea (MP4 71921 kb)

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Carriazo, C., Cosentino, M.J. (2021). Excimer Laser and Keratoconus. In: Carriazo, C., Cosentino, M.J. (eds) New Frontiers for the Treatment of Keratoconus. Springer, Cham. https://doi.org/10.1007/978-3-030-66143-4_8

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  • DOI: https://doi.org/10.1007/978-3-030-66143-4_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-66142-7

  • Online ISBN: 978-3-030-66143-4

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