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Femto-assisted cross-linking better than conventional: proof of concept of 'deeper the better'

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Session Details

Session Title: Cross-Linking

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:30

Paper Time: 14:06

Venue: Room 4.6

First Author: : L.Daniel Ponniah INDIA

Co Author(s): :    A. Agarwal                    

Abstract Details


To compare femto laser assisted crosslinking outcomes with conventional procedures, and to prove the concept of deeper stromal crosslinking better dampens progression of ectasias


Prospective non randomized controlled clinical trial at Cornea and Refractive surgery department, Dr. Agarwals Eye Hospital, Tirunelveli, South India


Femtosecond laser assisted CXL (creation of a corneal stromal bed of 8.5-9.0 mm diameter, 140-160 microns deep with two incisions 180 degrees apart, into which riboflavin A is infused in addition to transepithelial application) was compared with conventional epi-off CXL. Principal outcomes included uncorrected and corrected visual acuities, central pachymetry, topography derived K max value, astigmatism, AS-OCT derived demarcation line (DL). Statistical analysis between femto CXL and conventional groups and historic samples of accelerated, transepithelial and iontophoresis groups were arrived.


17 femto-CXL, 21 conventional-CXL eyes enrolled. Follow-up 1year. UCVA improved by 2 lines & 1 line in femto-CXL and conventional-CXL respectively (p=0.005). Central pachymetry was maintained in femto-CXL and reduced by 25 microns (p<0.05) in conventional-CXL. Femto-CXL was better (p=0.01) in retention of corneal thickness. Crosslinking flattens cornea in both groups. Astigmatism reduced in femto-CXL by 0.25D and increased by 0.27D in conventional-CXL. DL detected at 1 month, deep in femto-CXL (423 +/- 34.1 microns) versus (243 +/- 15.9 microns) in conventional-CXL (p<0.0001). Femto stromal bed enables deeper crosslinking than any other modalities. No endothelial changes in both groups


Crosslinking of posterior corneal stroma deeper than 250 microns could only be achieved with femto laser assisted CXL than any other conventional procedures, favouring an effective stabilisation of keratoconus in terms of preventing steepening and further thinning of cornea, as a proof of “Deeper the Better” concept.

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