title: Epithelial remodeling after femtosecond laser-assisted high myopic LASIK: comparison of stand-alone with LASIK combined with prophylactic high-fluence cross-linking.
abstract: OBJECTIVE
  The aim of this study was to evaluate the possible topographic epithelial profile thickness changes (remodeling) after high myopic femtosecond laser in situ keratomileusis (LASIK) with concurrent prophylactic high-fluence cross-linking (CXL) in comparison with standard femtosecond LASIK.
  
  
  METHODS
  Preoperative and 6-month postoperative 3-dimensional epithelial thickness distribution maps were investigated through clinical spectral domain anterior-segment optical coherence tomography in 2 groups of femtosecond laser-assisted myopic LASIK cases. Group A represented 67 eyes treated additionally with concurrent prophylactic CXL (LASIK-Xtra); group B represented 72 eyes subjected to stand-alone femtosecond LASIK. Optical coherence tomography measurements of the epithelial thickness over the center 2-mm-diameter disk, mid-peripheral 5-mm rim, and overall (the entire 6-mm-diameter disc area) were investigated.
  
  
  RESULTS
  The comparison of matched myopic correction subgroups indicated statistically significant differences in the epithelial thickness increase specifically between high myopia subgroups. For example, in group A (LASIK-Xtra), the mid-peripheral epithelial thickness increase was +3.79 and +3.95 μm for the "-8.00 to -9.00 diopter" and "-7.00 to -8.00 diopter" subgroups, which compare with increased thickness in group B (stand-alone LASIK), of +9.75 μm (P = 0.032) and +7.14 μm (P = 0.041), respectively, for the same subgroups.
  
  
  CONCLUSIONS
  Application of prophylactic CXL concurrently with high myopic LASIK operation results in a statistically significant reduced epithelial increase in comparison with stand-alone LASIK. This comparison is observed between matched high myopic correction subgroups. This difference may correlate with higher regression rates and/or may depict increased biomechanical instability in stand-alone LASIK.
authors.affiliation: *LaserVision.gr Eye Institute, Athens, Greece; and †Department of Ophthalmology, Langone Medical Center, NYU Medical School, New York, NY.
authors.forename: Anastasios J
authors.initials: AJ
authors.lastname: Kanellopoulos
authors.forename: George
authors.initials: G
authors.lastname: Asimellis
mesh_terms: D000293:Adolescent; D000328:Adult; D003094:Collagen / Q000378:metabolism; D003131:Combined Modality Therapy; D003319:Corneal Stroma / Q000187:drug effects / Q000378:metabolism; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D004847:Epithelial Cells / Q000502:physiology; D019573:Epithelium, Corneal / Q000502:physiology*; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D047728:Myopia, Degenerative / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D011184:Postoperative Period; D012256:Riboflavin / Q000627:therapeutic use; D041623:Tomography, Optical Coherence; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin