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Updated: Apr 29, 2026
Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis
Published on: November 12, 2015
In vivo confocal laser microscopy of morphologic changes after simultaneous LASIK and accelerated collagen
Minoru Tomita1, Yuko Yoshida1, Yusuke Yamamoto1
1From Shinagawa LASIK Center (Tomita, Yoshida, Yamamoto, Mita), Tokyo, Japan; the Department of Ophthalmology (Tomita), Wenzhou Medical College, Wenzhou, China; Medical University of South Carolina Storm Eye Institute (Waring) and Magill Vision Center (Waring), Charleston, South Carolina, and the Department of Bioengineering (Waring), College of Engineering and Science, Clemson University, Clemson, South Carolina, USA.
Purpose:
To evaluate the safety of corneal collagen crosslinking (CXL) combined with laser in situ keratomileusis (LASIK).
Setting:
Shinagawa LASIK Center, Tokyo, Japan.
Design:
Case series.
Methods:
Bilateral myopic LASIK patients had unilateral accelerated CXL (KXL System) in the nondominant eye. After LASIK, riboflavin 0.1% was instilled in the residual stromal bed for 60 seconds. After the riboflavin was washed out and the flap placed in its original position, ultraviolet-A light (30 mW/cm(2)) was administered for 60 seconds. The LASIK-CXL eyes and the LASIK-only eyes were compared. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction spherical equivalent (MRSE), keratometry values, endothelial cell density (ECD), pachymetry, optical coherence tomography (OCT), corneal hysteresis (CH), corneal resistance factor (CRF), keratoconus match index (KMI), and 37 parameters from a dynamic bidirectional applanation device (Ocular Response Analyzer) were analyzed. Morphologic changes were evaluated using confocal microscopy.
Results:
No significant differences in UDVA, CDVA, MRSE, ECD, dynamic bidirectional applanation readings (eg, CH, CRF, KMI), or 37 additional parameters were found between the 2 groups (P>.05). Increased hyperreflectivity and a demarcation line similar to that seen after CXL were observed in the LASIK-CXL eyes. The demarcation line (mean depth 200.04 μm ± 27.01 [SD]; range 178 to 278 μm) was present in 23 eyes (95.8%); the line was well defined in 2 eyes (8.3%) and faint in 21 eyes (87.5%).
Conclusion:
Combined LASIK-CXL was safe, causing insignificant corneal biomechanical and morphologic changes similar to those with CXL treatment only.
Financial Disclosure:
No author has a financial or proprietary interest in any material or method mentioned.
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