Safe and effective corneal crosslinking

Denise Wajnsztajn MD

Corneal crosslinking (CXL) seems to offer a safe and effective means of stabilising or partially reversing the progression of LASIK-induced keratectasia with minimal complications, according to a study presented at the XXXIII Congress of the ESCRS in Barcelona, Spain.

“Our study with up to three years follow-up showed that CXL stopped the progression of post-LASIK ectasia in 88 per cent of cases in the first year, 96 per cent in the second year, and 100 per cent of cases in the third year. Best corrected visual acuity (BCVA) improved by one line or more in over half of patients, and less than nine per cent recorded a loss of two lines of BCVA,” said Denise Wajnsztajn MD.

Post-LASIK ectasia is a rare complication of refractive surgery, said Dr Wajnsztajn, resulting in progressive central or inferior corneal steepening, thinning of the corneal stroma and loss of visual acuity after LASIK.

While the exact incidence of the disease is unknown, surveys by J Bradley Randleman MD have put the number at one in every 2,500 cases with older screening technology and one in 5,000 or less with appropriate screening.

“Although CXL is the only method capable of stopping or delaying the progression of post-LASIK ectasia, there is limited data on the long-term effect of the procedure to prevent further deterioration,” she said.

Dr Wajnsztajn presented a retrospective review of 36 eyes of 29 patients with a mean age of 34 years who underwent CXL for post-LASIK ectasia between August 2007 and July 2015. All CXL procedures were carried out using the standard Dresden protocol with regular or hypotonic riboflavin.

The results showed good stability in terms of corneal topography (Kmax) after 12 months, 24 months and three years, said Dr Wajnsztajn. The Kmax outcomes showed improvement (decrease of one or more dioptres) at 12 months in 59 per cent, stability in 29 per cent and deterioration (increase of one or more diopters) in 12 per cent of patients. The figures for 24 months showed improvement in 62.5 per cent, stability in 33 per cent and deterioration in four per cent. This trend continued at 36 months, with 65 per cent showing improvement, 35 per cent remaining stable and a decline in none, she said.

The BCVA outcomes were also encouraging, said Dr Wajnsztajn, with an improvement at 36 months in 59 per cent of patients, stability in 29 per cent and a decline in 12 per cent. There was no loss of more than two lines of BCVA throughout the study period.

Adverse events included six patients with early ocular surface complications: sterile infiltrates in two eyes (contact lens-related), mild diffuse lamellar keratitis (DLK) in one eye, and peripheral ingrowths of less than 1mm in three eyes. Corneal haze was also present in five eyes but there was no associated loss of BCVA, she said.

Denise Wajnsztajn: denisewaj@gmail.com