ABSTRACT
PURPOSE: To report visual, refractive, and topographic outcomes of sequential, same-day small-incision lenticule extraction and intrastromal corneal collagen crosslinking (CXL) in eyes with mild keratoconus. SETTING: Institute of Ophthalmology Conde de Valenciana, Mexico City, Mexico. DESIGN: Prospective interventional case series. METHODS: Fifteen eyes with forme fruste keratoconus and/or irregular corneas, corrected distance visual acuity 20/40 or better, stable refraction of at least 1 year, age 18 years or older, and residual corneal thickness of greater tan 400 µm before performing collagen crosslinking were studied. Patients were treated with small-incision lenticule extraction followed by intrastromal injection of riboflavin inside the pocket. Ultraviolet A light with a wavelength of 370 nm to 3 mW/cm(2) was applied for 30 minutes. Follow-up was done at 1 day, at 1 week, and at 1, 3, 6, 12, 18, and 24 months. RESULTS: Eight patients were included in the study. The mean age was 29.5 years ± 5.5 (SD) (range 20 to 36 years). Twenty-four months of follow-up were completed in 13 eyes, and 12 months were completed in 2 eyes. Preoperative uncorrected distance visual acuity improved from 1.6 ± 0.3 LogMAR (Snellen 20/796) to postoperative 0.12 ± 0.20 LogMAR (Snellen 20/26) and was statistically significant (P < .001). Best-corrected distance visual acuity did not change significantly (P = .186), from 0.006 ± 0.02 LogMAR (Snellen 20/20) preoperatively to 0.04 ± 0.05 LogMAR (Snellen 20/21) postoperatively, and spherical equivalent improved from -4.3 ± 1.02 preoperatively to 0.2 ± 0.66 (P < .001). CONCLUSION: Although further follow-up and larger samples are needed to fully confirm these findings, the results suggest that combined small-incision lenticule extraction and intrastromal corneal collagen crosslinking are a promising treatment option for patients for whom conventional laser refractive surgery is contraindicated. FINANCIAL DISCLOSURE: Drs. Ramirez-Miranda and Navas are consultants to Carl Zeiss Meditec. No other author has a financial or proprietary interest in any material or method mentioned.
Subject(s)
Collagen/metabolism , Corneal Stroma/surgery , Corneal Surgery, Laser , Cross-Linking Reagents , Keratoconus/therapy , Photosensitizing Agents/therapeutic use , Adult , Combined Modality Therapy , Corneal Stroma/drug effects , Corneal Stroma/metabolism , Corneal Topography , Female , Follow-Up Studies , Humans , Keratoconus/drug therapy , Keratoconus/physiopathology , Keratoconus/surgery , Lasers, Excimer/therapeutic use , Male , Photochemotherapy , Prospective Studies , Refraction, Ocular/physiology , Riboflavin/therapeutic use , Ultraviolet Rays , Visual Acuity/physiology , Young AdultABSTRACT
PURPOSE: To demonstrate the effectiveness of refractive surgery with an excimer laser to correct hyperopia and convergent strabismus caused by compensatory accommodation of refractive error. DESIGN: Prospective, interventional, noncomparative case series. PARTICIPANTS: Forty-six eyes of 23 patients with hyperopia and fully or partially refractive accommodative esotropia. METHODS: Patients were treated with an excimer laser and the LASIK technique between 2000 and 2010. MAIN OUTCOME MEASURES: Preoperative and postoperative refractive spherical equivalent and ocular alignment. RESULTS: Mean age ± standard deviation [SD] was 25 ± 12.6 years. Mean hyperopia ± SD was 3.67 ± 1.28 diopters (D) before surgery and 0.21 ± 0.59 D after surgery (P<0.001). The mean angle of deviation without correction was 21.0 prism diopters (Δ) before surgery and 3.7 Δ after surgery (P<0.001). CONCLUSIONS: Refractive surgery with excimer laser is a promising option for the treatment of refractive accommodative esotropia. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
