Combined laser in situ keratomileusis and prophylactic high-fluence corneal collagen crosslinking for high myopia: two-year safety and efficacy.
OBJECTIVE
To evaluate the safety, efficacy, and refractive and keratometric stability of myopic femtosecond laser in situ keratomileusis (LASIK) with concurrent prophylactic high-fluence corneal collagen crosslinking (CXL) compared with the outcomes of standard femtosecond LASIK.


METHODS
Private clinical practice, Athens, Greece.


METHODS
Consecutive randomized prospective comparative study.


METHODS
Eyes that had myopic LASIK or myopic LASIK with concurrent high-fluence CXL were evaluated preoperatively and up to 2 years postoperatively for manifest refraction spherical equivalent (MRSE), refractive astigmatism, visual acuity, corneal keratometry (K), and endothelial cell count.


RESULTS
One hundred forty consecutive eyes had myopic LASIK; 65 of the eyes were treated additionally with CXL. In the LASIK-CXL eyes, the mean postoperative MRSE was -0.18 diopter (D) ± 17.0 (SD) from -6.67 ± 2.14 D preoperatively. The postoperative flat K was 37.67 D from 43.92 D, and the steep K was 38.38 D from 45.15 D. The correlation coefficient of SE correction predictability was 0.975. In the LASIK-only eyes, the mean postoperative MRSE was -0.32 ± 0.24 D from -5.49 ± 1.99 D preoperatively. The flat K was 38.04 D from 43.15 D, and the steep K was 38.69 D from 44.03 D. The correlation coefficient of SE correction predictability was 0.968. The differences between the 2 groups at the 20/20 and 20/25 levels were statistically significant (P = .045 and P = .039, respectively).


CONCLUSIONS
Two-year results indicate that the application of prophylactic CXL concurrently with high-myopic LASIK appears to improve refractive and keratometric stability, presumably by affecting corneal biomechanical properties.


BACKGROUND
Dr. Kanellopoulos is a consultant to Alcon Surgical, Inc., Wavelight Laser Technologie AG, Allergan, Inc., Avedro, Inc., and i-Optics Corp. Dr. Asimellis has no financial or proprietary interest in any material or method mentioned.
From Laservision.gr Eye Institute (Kanellopoulos, Asimellis), Athens, Greece; New York University Medical School (Kanellopoulos), New York, New York, USA. Electronic address: ajk@brilliantvision.com.
Anastasios John
AJ
Kanellopoulos
From Laservision.gr Eye Institute (Kanellopoulos, Asimellis), Athens, Greece; New York University Medical School (Kanellopoulos), New York, New York, USA.
George
G
Asimellis
D000293:Adolescent; D000328:Adult; D002452:Cell Count; D003094:Collagen / Q000378:metabolism*; D003131:Combined Modality Therapy; D063171:Corneal Pachymetry; D003319:Corneal Stroma / Q000378:metabolism*; D003432:Cross-Linking Reagents; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D047728:Myopia, Degenerative / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D012256:Riboflavin / Q000627:therapeutic use; D013524:Surgical Flaps; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents; D003094:Collagen; D012256:Riboflavin