Official ESCRS | European Society of Cataract & Refractive Surgeons


Epithelium-on photorefractive intrastromal cross-linking (PIXL) with supplemental oxygen for low hyperopic and early presbyopic treatment

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Session Details

Session Title: Corneal Cross-Linking

Session Date/Time: Monday 16/09/2019 | 16:00-18:00

Paper Time: 17:36

Venue: South 5

First Author: : W.Lim SINGAPORE

Co Author(s): :    J. Siew   C. Chua   F. Khoo   F. Gasper                    

Abstract Details


To report the 12 months results of low hyperopic and presbyopic correction with epithelium-on PiXL with supplementary oxygen in 23 eyes of 17 subjects.


This pilot project was done in a clinical setting as an investigator initiated research study and approved by our Institution Review Board.


PiXL procedure was conducted on patients with normal (non-ectatic) corneas for hyperopic treatment. PiXL treatments were designed to deliver a 9mm annulus ring of 1mm thickness of UVA light with supplemental oxygen at a rate of 2mL/minute. Clinical evaluation included safety (BCVA, ECC, anterior ocular health) and efficacy (UCVA, manifest refraction, k-mean) examinations. 8 eyes were treated for distance vision (aim plano) while 15 eyes were treated for near vision (aim minus). Moreover, patient’s subjective experience with PiXL was evaluated with questionnaire during 1st, 6th and 12th months post procedure review.


23 ametropic eyes (median +0.75Ds, range -0.88 to +1.50Ds) of 17 subjects (mean age 49 years old; range 38 to 60 years old) were assessed. 12-month data showed a median refractive error of +0.31Ds (range -1.13 to +0.88Ds) and median k-mean flattening of 0.40D (range 0.2 to 1.0D). Median UDVA improved from 0.12 logMAR pre-piXL to 0.00 logMAR (range -0.06 to 0.02) at 12-month while median UNVA improved from N12 pre-piXL to N6 (range N12 to N5) at 12-month. In addition, there were insignificant changes to the ECC, no loss of BCVA, no cases of infections and permanent corneal haze.


Epithelium-on PiXL with oxygen was a safe and effective refractive option for patients with low hyperopia and presbyopia in this study with up to 12 months follow-up. Although PiXL was able to produce stabilised results from 3-month onwards, longer-term data in larger sample sizes are required to assess the sustainability of the treatment.

Financial Disclosure:

research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented

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