Purchase this article with an account.
Enrique O Graue, Arturo J Ramirez-Miranda, Gabriela L Pagano, Guillermo Garcia de la Rosa, Alejandro Navas; Long term outcomes of combined small incision lenticule extraction and simultaneaneous intrastromal cross-linking in keratoconus. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2139.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report long term visual, refractive and topographic outcomes of sequential same-day Small Incision Lenticule Extraction (SMILE) and intrastromal corneal collagen cross-linking in keratoconus
Methods: Prospective, interventionl case series. Inclusion criteria were: topographic diagnosis of forme fruste keratoconus , CDVA ≥20/40, stable refraction of at least 1 year, patients aged ≥21 years and expected residual corneal thickness > 400 μm before performing collagen cross-linking. Patients were treated with SMILE (VisuMax - Carl Zeiss Meditec) followed by intrastromal injection of riboflavin inside the pocket. Ultraviolet A light (IROC AG, Zurich, Switzerland[) wavelength of 370 nm to 3-mW/cm2 was applied for 30 minutes in each eye. Follow-up was done at day 1, 1 week, 1-3-6-12 and 18months. Study parameters were UDVA, CDVA, manifest refraction, and tomographic and clinical evaluations.
12 eyes of 7 patients were treated with SMILE and CXL. Mean age of the patients was 29.9 + 5.50 years. Seventy percent were males. The average of follow-up was 12.9 months. 8 eyes completed a year of follow up. Refractive results at one-year of follow up showed a preoperative and postoperative UDVA of logMAR 1.35 and logMAR 0.07 respectively (p<0.001). Mean preoperative and postoperative CDVA were logMAR 0.01 and logMAR 0.03 (p> 0.001). Preoperative and postoperative spherical equivalent were -3.69 D (range: -2.12 to -5.87) and 0.08 D (range: 0 to 1.5) respectively, (p < 0.001). Sixty seven percent and 83% of the eyes were between +0.50 and +1.00 D of postoperative spherical equivalent. Preoperative and postoperative refractive astigmatism were -2.15 D and -0.66 D respectively (p< 0.001). Eighty-three percent of the eyes were < 1.00 D. At one year of follow-up, 100% was 20/32 or better of UDVA. The efficacy index was 7.16. Related to safety, 4 eyes maintained the same CDVA in the postoperative period and 2 eyes loss 1 line of CDVA in comparison with preoperative CDVA. A good correlation was found between attempted vs. achieved spherical equivalent refraction, R2= 0.98091.
Combined SMILE and Cross-linking may be a promising treatment option in patients where conventional laser refractive surgery is contraindicated.
This PDF is available to Subscribers Only