title: In vivo confocal laser microscopy of morphologic changes after simultaneous LASIK and accelerated collagen crosslinking for myopia: one-year results.
abstract: OBJECTIVE
  To evaluate the safety of corneal collagen crosslinking (CXL) combined with laser in situ keratomileusis (LASIK).
  
  
  METHODS
  Shinagawa LASIK Center, Tokyo, Japan.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Bilateral myopic LASIK patients had unilateral accelerated CXL (KXL System) in the nondominant eye. After LASIK, riboflavin 0.1% was instilled in the residual stromal bed for 60 seconds. After the riboflavin was washed out and the flap placed in its original position, ultraviolet-A light (30 mW/cm(2)) was administered for 60 seconds. The LASIK-CXL eyes and the LASIK-only eyes were compared. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction spherical equivalent (MRSE), keratometry values, endothelial cell density (ECD), pachymetry, optical coherence tomography (OCT), corneal hysteresis (CH), corneal resistance factor (CRF), keratoconus match index (KMI), and 37 parameters from a dynamic bidirectional applanation device (Ocular Response Analyzer) were analyzed. Morphologic changes were evaluated using confocal microscopy.
  
  
  RESULTS
  No significant differences in UDVA, CDVA, MRSE, ECD, dynamic bidirectional applanation readings (eg, CH, CRF, KMI), or 37 additional parameters were found between the 2 groups (P>.05). Increased hyperreflectivity and a demarcation line similar to that seen after CXL were observed in the LASIK-CXL eyes. The demarcation line (mean depth 200.04 μm ± 27.01 [SD]; range 178 to 278 μm) was present in 23 eyes (95.8%); the line was well defined in 2 eyes (8.3%) and faint in 21 eyes (87.5%).
  
  
  CONCLUSIONS
  Combined LASIK-CXL was safe, causing insignificant corneal biomechanical and morphologic changes similar to those with CXL treatment only.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From Shinagawa LASIK Center (Tomita, Yoshida, Yamamoto, Mita), Tokyo, Japan; the Department of Ophthalmology (Tomita), Wenzhou Medical College, Wenzhou, China; Medical University of South Carolina Storm Eye Institute (Waring) and Magill Vision Center (Waring), Charleston, South Carolina, and the Department of Bioengineering (Waring), College of Engineering and Science, Clemson University, Clemson, South Carolina, USA. Electronic address: tomita@shinagawa-lasik.com.
authors.forename: Minoru
authors.initials: M
authors.lastname: Tomita
authors.affiliation: From Shinagawa LASIK Center (Tomita, Yoshida, Yamamoto, Mita), Tokyo, Japan; the Department of Ophthalmology (Tomita), Wenzhou Medical College, Wenzhou, China; Medical University of South Carolina Storm Eye Institute (Waring) and Magill Vision Center (Waring), Charleston, South Carolina, and the Department of Bioengineering (Waring), College of Engineering and Science, Clemson University, Clemson, South Carolina, USA.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Yoshida
authors.affiliation: From Shinagawa LASIK Center (Tomita, Yoshida, Yamamoto, Mita), Tokyo, Japan; the Department of Ophthalmology (Tomita), Wenzhou Medical College, Wenzhou, China; Medical University of South Carolina Storm Eye Institute (Waring) and Magill Vision Center (Waring), Charleston, South Carolina, and the Department of Bioengineering (Waring), College of Engineering and Science, Clemson University, Clemson, South Carolina, USA.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: From Shinagawa LASIK Center (Tomita, Yoshida, Yamamoto, Mita), Tokyo, Japan; the Department of Ophthalmology (Tomita), Wenzhou Medical College, Wenzhou, China; Medical University of South Carolina Storm Eye Institute (Waring) and Magill Vision Center (Waring), Charleston, South Carolina, and the Department of Bioengineering (Waring), College of Engineering and Science, Clemson University, Clemson, South Carolina, USA.
authors.forename: Mariko
authors.initials: M
authors.lastname: Mita
authors.affiliation: From Shinagawa LASIK Center (Tomita, Yoshida, Yamamoto, Mita), Tokyo, Japan; the Department of Ophthalmology (Tomita), Wenzhou Medical College, Wenzhou, China; Medical University of South Carolina Storm Eye Institute (Waring) and Magill Vision Center (Waring), Charleston, South Carolina, and the Department of Bioengineering (Waring), College of Engineering and Science, Clemson University, Clemson, South Carolina, USA.
authors.forename: George
authors.initials: G
authors.lastname: Waring
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002452:Cell Count; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism / Q000473:pathology*; D019781:Corneal Topography; D003432:Cross-Linking Reagents / Q000627:therapeutic use*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D018613:Microscopy, Confocal; D009216:Myopia / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017319:Photosensitizing Agents / Q000627:therapeutic use; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use; D014466:Ultraviolet Rays; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin