Standard cross‐linking versus photorefractive keratectomy combined with accelerated cross‐linking for keratoconus management: a comparative study

Autor: Ahmed M. Tawfik, Ashraf T Soliman, Amin Abou Ali, Omar Fawzy, Osama Ali, Ahmed Elmassry, Mohammed Iqbal, Alaa Radwan, Islam Saad El Saman, Khaled Nagy, Ahmed Am Gad, Hosam Elzembely, Mervat Elshabrawy Elgharieb, Tarek Tawfik, Hisham A Saad
Rok vydání: 2018
Předmět:
Male
PRK
Riboflavin
medicine.medical_treatment
Visual Acuity
Spherical equivalent
law.invention
Cornea
CXL‐Plus
ectasia
Clinical study
0302 clinical medicine
law
Medicine
Prospective Studies
standard CXL
Photosensitizing Agents
General Medicine
Objective refraction
Photorefractive keratectomy
epithelium‐off CXL
Cross-Linking Reagents
Treatment Outcome
Female
Lasers
Excimer
Original Article
Collagen
Adult
medicine.medical_specialty
Keratoconus
Adolescent
Ultraviolet Rays
keratoconus
Refraction
Ocular
Photorefractive Keratectomy
Young Adult
03 medical and health sciences
Ophthalmology
Humans
Keratometer
business.industry
Corneal Topography
Original Articles
medicine.disease
eye diseases
Photochemotherapy
030221 ophthalmology & optometry
business
030217 neurology & neurosurgery
Follow-Up Studies
Zdroj: Acta Ophthalmologica
ISSN: 1755-3768
1755-375X
Popis: Purpose To compare the safety and efficacy of standard 30 min epithelium‐off cross‐linking (CXL) versus photorefractive keratectomy (PRK) combined with accelerated epithelium‐off cross‐linking (AXL) for the treatment of progressive keratoconus (CXL‐Plus). Methods This study was a prospective multicentre comparative clinical study. A total of 125 eyes of 75 patients with grade 1 keratoconus and documented progression were divided into two groups. Group A included 58 eyes treated with standard CXL. Group B included 67 eyes treated with combined PRK and AXL. The recorded data included UDVA, CDVA, subjective and objective refraction, keratometry and pachymetry using corneal topographies preoperatively and postoperatively at 3, 6, 12 and 24 months of follow‐up. Results In group A, at 24 months of UDVA and CDVA were improved from 1.12 ± 0.38 and 0.58 ± 0.42 to 0.66 ± 0.20 and 0.20 ± 0.12 (LogMAR±SD). The spherical equivalent was reduced from 4.03 ± 1.18 to 1.78 ± 1.04 D. The cylinder reduction was 0.32 ± 0.19 D. In group B, at 24 months of UDVA and CDVA were improved from 1.26 ± 0.52 and 0.68 ± 0.36 to 0.58 ± 0.28 and 0.20 ± 0.16 (LogMAR ± SD). The spherical equivalent was reduced from 4.23 ± 0.95 to 1.92 ± 0.74 D. The cylinder reduction was ±1.76 D. Conclusion Surprisingly, standard CXL showed close results to CXL‐Plus at the 24th follow‐up month. Standard CXL acted as a stabilizing procedure associated with a late myopic component reduction. CXL‐Plus acted as a refractive and stabilizing procedure with an early effect on both the myopic and the astigmatic component but no later improvements. Standard CXL seems to be more powerful than AXL in its long‐term effect. Therefore, in the future, we want to test the combination of PRK with standard CXL.
Databáze: OpenAIRE
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