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Standard cross‐linking versus photorefractive keratectomy combined with accelerated cross‐linking for keratoconus management: a comparative study
Author(s) -
Iqbal Mohammed,
Elmassry Ahmed,
Tawfik Ahmed,
Elgharieb Mervat,
Nagy Khaled,
Soliman Ashraf,
Saad Hisham,
Tawfik Tarek,
Ali Osama,
Gad Ahmed,
El Saman Islam,
Radwan Alaa,
Elzembely Hosam,
Abou Ali Amin,
Fawzy Omar
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13986
Subject(s) - keratoconus , keratometer , photorefractive keratectomy , ophthalmology , medicine , corneal collagen cross linking , corneal pachymetry , clinical study , surgery , cornea
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 (Log MAR ± 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 (Log MAR ± 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 .