Under-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique

Avi Wallerstein,1,2 Eser Adiguzel,2 Mathieu Gauvin,1,2 Nima Mohammad-Shahi,1 Mark Cohen2,3 1Department of Ophthalmology, Faculty of Medicine, McGill University, 2LASIK MD, Montreal, 3Department of Surgery, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada Pu...

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Autores principales:	Wallerstein A, Adiguzel E, Gauvin M, Mohammad-Shahi N, Cohen M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	CXL LASIK ufCXL Post-LASIK Ectasia Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/e4d697111b784b8d83e6a6d2670a9a75
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spelling	oai:doaj.org-article:e4d697111b784b8d83e6a6d2670a9a752021-12-02T00:21:39ZUnder-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique1177-5483https://doaj.org/article/e4d697111b784b8d83e6a6d2670a9a752016-12-01T00:00:00Zhttps://www.dovepress.com/under-flap-stromal-bed-cxl-for-early-post-lasik-ectasia-a-novel-treatm-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Avi Wallerstein,1,2 Eser Adiguzel,2 Mathieu Gauvin,1,2 Nima Mohammad-Shahi,1 Mark Cohen2,3 1Department of Ophthalmology, Faculty of Medicine, McGill University, 2LASIK MD, Montreal, 3Department of Surgery, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada Purpose: Collagen cross-linking (CXL) for post-laser-assisted in situ keratomileusis (LASIK) ectasia (PLE) is traditionally performed either epi-on or epi-off on the corneal surface. This study describes a novel technique in treating early PLE with under-flap CXL (ufCXL) to the stromal bed and reports on 6-month outcomes.Patients and methods: Case series of seven patients (eight eyes) with topography-diagnosed early PLE treated with ufCXL. Inclusion criteria were early, mild PLE defined as new-onset postoperative manifest refraction cylinder ≤1.50 D, with new topographic inferior steepening consistent with ectasia, uncorrected distance visual acuity (UDVA) of 20/40 or better, and corrected distance visual acuity (CDVA) of 20/25 or better. Existing LASIK flap was lifted, riboflavin was applied directly to the stromal bed, flap was repositioned, and 18 mW/cm2 ultraviolet light was applied for 3 minutes to the corneal surface. Post-ufCXL manifest refraction, UDVA and CDVA, corneal cylinder, Kmax, and corneal irregularity index were compared with pre-ufCXL measurements.Results: Patients had a pre-ufCXL sphere of 0.09±0.48 D and cylinder of −0.78±0.49 D. At 6 months, post-ufCXL sphere (0.06±0.8 D; P=0.89) and cylinder (−1.09±0.76 D, P=0.26) were unchanged. Cumulative post-ufCXL UDVA was unchanged, achieving 20/20, 20/30, and 20/40 in 25%, 88%, and 88%, respectively, compared with 13%, 63%, and 88% pre-ufCXL (P=0.68). Post-ufCXL CDVA was unchanged (P=0.93) with a gain of one line in two eyes, a loss of one line in one eye, and five eyes unchanged. The efficacy index (P=0.76), safety index (P=0.89), Kmax (P=0.94), and corneal irregularity index (P=0.73) were also unchanged.Conclusion: Preliminary results with ufCXL for early PLE are promising, demonstrating maintenance of visual accuracy, efficacy, safety, Kmax, and cylinder, with much quicker recovery times than surface CXL. Keywords: CXL, LASIK, ufCXL, post-LASIK ectasia, cross-linking, LASIK complications, stromal bedWallerstein AAdiguzel EGauvin MMohammad-Shahi NCohen MDove Medical PressarticleCXLLASIKufCXLPost-LASIK EctasiaOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 11, Pp 1-8 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	CXL LASIK ufCXL Post-LASIK Ectasia Ophthalmology RE1-994
spellingShingle	CXL LASIK ufCXL Post-LASIK Ectasia Ophthalmology RE1-994 Wallerstein A Adiguzel E Gauvin M Mohammad-Shahi N Cohen M Under-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique
description	Avi Wallerstein,1,2 Eser Adiguzel,2 Mathieu Gauvin,1,2 Nima Mohammad-Shahi,1 Mark Cohen2,3 1Department of Ophthalmology, Faculty of Medicine, McGill University, 2LASIK MD, Montreal, 3Department of Surgery, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada Purpose: Collagen cross-linking (CXL) for post-laser-assisted in situ keratomileusis (LASIK) ectasia (PLE) is traditionally performed either epi-on or epi-off on the corneal surface. This study describes a novel technique in treating early PLE with under-flap CXL (ufCXL) to the stromal bed and reports on 6-month outcomes.Patients and methods: Case series of seven patients (eight eyes) with topography-diagnosed early PLE treated with ufCXL. Inclusion criteria were early, mild PLE defined as new-onset postoperative manifest refraction cylinder ≤1.50 D, with new topographic inferior steepening consistent with ectasia, uncorrected distance visual acuity (UDVA) of 20/40 or better, and corrected distance visual acuity (CDVA) of 20/25 or better. Existing LASIK flap was lifted, riboflavin was applied directly to the stromal bed, flap was repositioned, and 18 mW/cm2 ultraviolet light was applied for 3 minutes to the corneal surface. Post-ufCXL manifest refraction, UDVA and CDVA, corneal cylinder, Kmax, and corneal irregularity index were compared with pre-ufCXL measurements.Results: Patients had a pre-ufCXL sphere of 0.09±0.48 D and cylinder of −0.78±0.49 D. At 6 months, post-ufCXL sphere (0.06±0.8 D; P=0.89) and cylinder (−1.09±0.76 D, P=0.26) were unchanged. Cumulative post-ufCXL UDVA was unchanged, achieving 20/20, 20/30, and 20/40 in 25%, 88%, and 88%, respectively, compared with 13%, 63%, and 88% pre-ufCXL (P=0.68). Post-ufCXL CDVA was unchanged (P=0.93) with a gain of one line in two eyes, a loss of one line in one eye, and five eyes unchanged. The efficacy index (P=0.76), safety index (P=0.89), Kmax (P=0.94), and corneal irregularity index (P=0.73) were also unchanged.Conclusion: Preliminary results with ufCXL for early PLE are promising, demonstrating maintenance of visual accuracy, efficacy, safety, Kmax, and cylinder, with much quicker recovery times than surface CXL. Keywords: CXL, LASIK, ufCXL, post-LASIK ectasia, cross-linking, LASIK complications, stromal bed
format	article
author	Wallerstein A Adiguzel E Gauvin M Mohammad-Shahi N Cohen M
author_facet	Wallerstein A Adiguzel E Gauvin M Mohammad-Shahi N Cohen M
author_sort	Wallerstein A
title	Under-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique
title_short	Under-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique
title_full	Under-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique
title_fullStr	Under-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique
title_full_unstemmed	Under-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique
title_sort	under-flap stromal bed cxl for early post-lasik ectasia: a novel treatment technique
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/e4d697111b784b8d83e6a6d2670a9a75
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Under-flap stromal bed CXL for early post-LASIK ectasia: a novel treatment technique

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