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Does Adjunctive Under-flap CXL Reduce Regression for Hyperopic LASIK?

Avi Wallerstein, Mathieu Gauvin, Harrison Watt

    Journal of Refractive Surgery (Thorofare, N.J. : 1995)
    |December 8, 2022
    PubMed
    Summary

    Adding accelerated corneal cross-linking to hyperopic LASIK did not change refractive outcomes or stability. However, it showed a trend towards lower efficacy and subjective vision quality.

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    Area of Science:

    • Ophthalmology
    • Refractive Surgery
    • Corneal Cross-linking

    Background:

    • Hyperopic laser in situ keratomileusis (LASIK) is a common procedure for correcting farsightedness.
    • Corneal cross-linking (CXL) strengthens the cornea and is used to treat progressive keratectasias.
    • Accelerated under-flap corneal cross-linking (ufCXL) is a modification of the CXL procedure.

    Purpose of the Study:

    • To evaluate the impact of adding accelerated ufCXL to hyperopic LASIK.
    • To assess effects on postoperative stability, regression, visual acuity, and refractive outcomes.
    • To determine changes in subjective quality of vision and night vision disturbances.

    Main Methods:

    • Prospective comparative study of 51 patients with hyperopia.
    • Contralateral eyes received either LASIK-ufCXL or LASIK alone.
    • Primary outcome: spherical equivalent stability at 24 months; Secondary outcomes: visual acuity, refractive error, subjective vision quality, and corneal haze.

    Main Results:

    • No significant differences in spherical equivalent stability or hyperopic regression between LASIK-ufCXL and LASIK alone at 24 months.
    • Trends suggested less hyperopic regression in the LASIK-ufCXL group.
    • No significant differences in accuracy, efficacy, or safety, but a trend towards more residual astigmatism and lower subjective vision quality in the LASIK-ufCXL group.

    Conclusions:

    • Hyperopic LASIK with or without accelerated ufCXL demonstrated statistically equivalent postoperative regression and stability.
    • Safety outcomes were identical between the two procedures.
    • Small clinical trends indicated potentially lower efficacy, accuracy, and subjective vision quality with LASIK-ufCXL.