title: Same-day intrastromal corneal ring segment and collagen cross-linking for ectasia after laser in situ keratomileusis: long-term results.
abstract: OBJECTIVE
  To report the long-term results of combined same-day intrastromal corneal ring segment placement and corneal collagen cross-linking (CXL) for postoperative laser in situ keratomileusis (LASIK) ectasia.
  
  
  METHODS
  Retrospective, interventional case series.
  
  
  METHODS
  This retrospective, interventional cases series was performed in Turkiye Hospital Eye Clinic and the Department of Ophthalmology, Fatih University Medical Faculty Hospital, Istanbul, Turkey. Sixteen eyes of 14 patients with postoperative ectasia after LASIK were enrolled. All consecutive patients were treated with femtosecond laser-assisted intrastromal corneal ring segment implantation and followed by same-day corneal collagen cross-linking for ectasia occurring after LASIK. Main outcome measures included uncorrected distance visual acuity, corrected distance visual acuity, spherical and cylindrical refraction, and simulated keratometry values.
  
  
  RESULTS
  The mean age ± standard deviation of the 10 women and 4 men was 33.0 ± 6.5 years (range, 23 to 44 years), and the mean follow-up was 43 months (range, 36 to 62 months). The uncorrected distance visual acuity improved significantly from 1.18 ± 0.42 logarithm of the minimal angle of resolution (logMAR) units to 0.44 ± 0.22 logMAR (P < .001), and the corrected distance visual acuity improved significantly from 0.46 ± 0.26 logMAR to 0.21 ± 0.14 logMAR (P < .001). The mean spherical and cylindrical refraction decreased significantly (P < .001 for both). The maximum keratometry value decreased from baseline by 49.3 ± 4.9 diopters (D) to 43.9 ± 2.8 D at the last visit, and the minimum keratometry value decreased from 44.3 ± 4.7 D to 41.5 ± 3.5 D (P < .001 for both). No serious complications were shown during follow-up.
  
  
  CONCLUSIONS
  Implantation of intrastromal corneal ring segment implantation combined with same-day corneal collagen cross-linking was a safe and effective treatment for ectasia occurring after LASIK. It also significantly improved the visual acuity, refraction, and keratometry values.
authors: Department of Ophthalmology, Fatih University Medical Faculty Hospital, Istanbul, Turkey. Electronic address: drayldrm@yandex.com.
authors: Aydin
authors: A
authors: Yildirim
authors: Department of Ophthalmology, Fatih University Medical Faculty Hospital, Istanbul, Turkey.
authors: Hasim
authors: H
authors: Uslu
authors: Department of Ophthalmology, Gaziantep Sehitkamil State Hospital, Istanbul, Turkey.
authors: Necip
authors: N
authors: Kara
authors: Turkiye Hospital Eye Clinic, Istanbul, Turkey.
authors: Hanefi
authors: H
authors: Cakir
authors: Department of Ophthalmology, Fatih University Medical Faculty Hospital, Istanbul, Turkey.
authors: Bulent
authors: B
authors: Gurler
authors: Department of Ophthalmology, Fatih University Medical Faculty Hospital, Istanbul, Turkey.
authors: Hatice Nur
authors: HN
authors: Colak
authors: Department of Ophthalmology, Beyoglu Eye Education and Research Hospital, Istanbul, Turkey.
authors: Engin Bilge
authors: EB
authors: Ozgurhan
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism; D003131:Combined Modality Therapy; D003316:Corneal Diseases / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism / Q000601:surgery*; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D004108:Dilatation, Pathologic / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D008297:Male; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications; D019736:Prostheses and Implants; D019919:Prosthesis Implantation; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D003094:Collagen; D019904:Polymethyl Methacrylate