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Hira S, Klein Heffel K, Mehmood F, Sehgal K, Felix De Farias Santos AC, Steuernagel Del Valle G. Comparison of refractive surgeries (SMILE, LASIK, and PRK) with and without corneal crosslinking: systematic review and meta-analysis. J Cataract Refract Surg 2024; 50:523-533. [PMID: 38288954 DOI: 10.1097/j.jcrs.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/22/2024] [Indexed: 04/24/2024]
Abstract
Corneal crosslinking (CXL) is used for treating keratoconus and post-laser in situ keratomileusis ectasia. However, refractive surgery is not usually performed with prophylactic CXL. Therefore, we performed a meta-analysis comparing outcomes of refractive surgeries with vs without prophylactic CXL. We systematically searched databases for studies comparing refractive surgeries for myopic correction with vs without prophylactic corneal crosslinking. Review Manager 5.4.1 was used to perform statistical analysis. We included 2820 eyes from 28 studies. Compared with refractive surgery alone, surgery with prophylactic CXL resulted in decreased central corneal thickness, corrected distance visual acuity logMAR, and safety and efficacy indices. There were no significant differences in postoperative uncorrected distance visual acuity of 20/20 or better at ≥12 months and other visual outcomes among both groups. More randomized controlled trials with standard crosslinking protocols are needed to analyze the prophylactic use of crosslinking with refractive surgeries.
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Affiliation(s)
- Sara Hira
- From the FMH College of Medicine & Dentistry, Lahore, Pakistan (Hira); Federal University of Pelotas, Pelotas, Brazil (Klein Heffel); Department of Ophthalmology, Fatima Memorial Hospital, Lahore, Pakistan (Mehmood); Teerthanker Mahaveer University, Moradabad, UP, India (Sehgal); City University of São Paulo, São Paulo, Brazil (Felix De Farias Santos); University of Iowa, Iowa City, Iowa (Steuernagel Del Valle)
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Chen W, Bao F, Roberts CJ, Zhang J, Wang C, Li X, Wang J, Abu Said AZM, Mayopa KN, Chen Y, Zheng X, Eliasy A, Elsheikh A, Chen S. Effect of corneal cross-linking on biomechanical changes following transepithelial photorefractive keratectomy and femtosecond laser-assisted LASIK. Front Bioeng Biotechnol 2024; 12:1323612. [PMID: 38558790 PMCID: PMC10978754 DOI: 10.3389/fbioe.2024.1323612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose: To evaluate the change in corneal biomechanics in patients with postoperative ectasia risk when combining two common laser vision correction procedures (tPRK and FS-LASIK) with cross-linking (in tPRK Xtra and FS-LASIK Xtra). Methods: The study included 143 eyes of 143 myopic, astigmatic patients that were divided into non-cross-linked refractive surgery groups (non-Xtra groups, tPRK and FS-LASIK) and cross-linked groups (Xtra groups, tPRK Xtra and FS-LASIK Xtra) according to an ectasia risk scoring system. The eyes were subjected to measurements including the stress-strain index (SSI), the stiffness parameter at first applanation (SP-A1), the integrated inverse radius (IIR), the deformation amplitude at apex (DA), and the ratio of deformation amplitude between apex and 2 mm from apex (DARatio2mm). The measurements were taken preoperatively and at 1, 3, and 6 months postoperatively (pos1m, pos3m, and pos6m). Posterior demarcation line depth from the endothelium (PDLD) and from the ablation surface (DLA) were recorded at pos1m. Results: SP-A1 significantly decreased, while IIR, deformation amplitude, and DARatio2mm increased significantly postoperatively in all four groups (p < 0.01)-all denoting stiffness decreases. In the FS-LASIK group, the changes in IIR, DA, and DARatio2mm were 32.7 ± 15.1%, 12.9 ± 7.1%, and 27.2 ± 12.0% respectively, which were significantly higher (p < 0.05) compared to 20.1 ± 12.8%, 6.4 ± 8.2%, and 19.7 ± 10.4% in the FS-LASIK Xtra group. In the tPRK group, the change in IIR was 27.3 ± 15.5%, significantly larger than 16.9 ± 13.4% in the tPRK Xtra group. The changes of SSI were minimal in the tPRK (-1.5 ± 21.7%, p = 1.000), tPRK Xtra (8.4 ± 17.9%, p = 0.053), and FS-LASIK Xtra (5.6 ± 12.7%, p = 0.634) groups, but was significant in the FS-LASIK group (-12.1 ± 7.9%, p < 0.01). After correcting for baseline biomechanical metrics, preoperative bIOP and the change in central corneal thickness (△CCT) from pre to pos6m, the changes in the IIR in both FS-LASIK and tPRK groups, as well as DA, DARatio2mm and SSI in the FS-LASIK group remained statistically greater than their corresponding Xtra groups (all p < 0.05). Most importantly, after correcting for these covariates, the changes in DARatio2mm in the FS-LASIK Xtra became statistically smaller than in the tPRK Xtra (p = 0.017). Conclusion: The statistical analysis results indicate that tPRK Xtra and FS-LASIK Xtra effectively reduced the biomechanical losses caused by refractive surgery (tPRK and FS-LASIK). The decrease in corneal overall stiffness was greater in FS-LASIK than in tPRK, and the biomechanical enhancement of CXL was also higher following LASIK than after tPRK.
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Affiliation(s)
- Wen Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - FangJun Bao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Sicence, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, WenZhou Medical University, Wenzhou, China
| | - Cynthia J. Roberts
- Ophthalmology and Visual Sciences and Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Jia Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Sicence, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chong Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - XueFei Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - JunJie Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Sicence, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, WenZhou Medical University, Wenzhou, China
| | - Anas Ziad Masoud Abu Said
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Kevin Nguelemo Mayopa
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - YaNi Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - XiaoBo Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Sicence, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, WenZhou Medical University, Wenzhou, China
| | - Ashkan Eliasy
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
| | - ShiHao Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- State Key Laboratory of Ophthalmology, Optometry and Vision Sicence, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, WenZhou Medical University, Wenzhou, China
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Changes in Corneal Morphology and Biomechanics in Cases of Small Incision Lenticule Extraction with Prophylactic Accelerated Collagen Cross-Linking. J Ophthalmol 2022; 2022:1640249. [PMID: 35859778 PMCID: PMC9293522 DOI: 10.1155/2022/1640249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/12/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To study the corneal morphology and biomechanics in cases of small incision lenticule extraction with prophylactic accelerated collagen cross-linking (SMILE Xtra). Methods This study was a retrospective study. 28 eyes of 14 patients with moderate-high risk of postoperative ectasia according to the Randleman scoring system underwent SMILE Xtra procedure. Outcome data were recorded including uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), surface regularity index (SRI), surface asymmetry index (SAI), simulated keratometry (SimK), posterior axial curvature (PAC), anterior and posterior corneal elevations (ACE and PCE), central corneal thickness (CCT), corneal resistance factor (CRF), corneal hysteresis (CH), and cornea-compensated intraocular pressure (IOPcc). The follow-up period was 12 months. Results There were 28, 26, 22, 12, and 10 eyes enrolled at postoperative 1st day and 1st, 3rd, 6th, and 12th months, respectively. The UDVA improved from 1.27 ± 0.18 logMAR preoperatively to -0.06 ± 0.04 logMAR postoperatively (P < 0.05). The MRSE improved from -5.05 ± 1.15 D preoperatively to -0.14 ± 0.30 D postoperatively (P < 0.05). SAI, SimK, PAC, PCE, and CCT all changed significantly at 1st month postoperatively (P < 0.05) and stabilized during the remainder of the follow-up (P > 0.05). There was no significant change in SRI or ACE before and after surgery (P > 0.05). CRF, CH, and IOPcc all decreased significantly at 1st month postoperatively (P < 0.05) and remained stable afterwards (P > 0.05). Conclusions The changes in the corneal morphology and biomechanics remained stable after SMILE Xtra, and there was no sign of postoperative ectasia or refractive regression. Combined with the improvement of visual and refractive results, SMILE Xtra may be a promising method for corneal refractive surgeries in patients at risk.
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