International Journal of Keratoconus and Ectatic Corneal Diseases

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VOLUME 11 , ISSUE 1 ( January-December, 2024 ) > List of Articles

Original Article

Corneal Collagen Cross-linking (CXL) Only vs CXL Combined with INTACS: 12-month Follow-up Data

Brendan K Cummings, Mehr Kaur, Joseph Zikry, Yaron Rabinowitz

Keywords : Athens protocol, Astigmatism, Collagen corneal cross-linking, Cornea, Cornea biomechanic, Cornea ectasia, Corneal collagen cross-linking, Intacs, Intrastromal corneal rings, Keratoconus

Citation Information : Cummings BK, Kaur M, Zikry J, Rabinowitz Y. Corneal Collagen Cross-linking (CXL) Only vs CXL Combined with INTACS: 12-month Follow-up Data. Int J Kerat Ect Cor Dis 2024; 11 (1):1-6.

DOI: 10.5005/jp-journals-10025-1200

License: CC BY-NC 4.0

Published Online: 13-11-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Purpose: To present 1-year data comparing the efficacy of the combination of CXL and INTACS vs CXL only in the treatment of keratoconus. Methods: The chart records of 25 eyes of 19 patients with keratoconus treated with CXL and INTACS between January 2011 and May 2013 were retrospectively reviewed. The outcomes of this combined procedure were compared with the outcomes of 143 eyes of 109 patients treated by CXL only. The following parameters were studied and outcomes were evaluated at 12 months postoperatively: uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), keratometry (Max K and Average K), and spherical equivalent. Results: Uncorrected visual acuity at 12 months following CXL+INTACS was significantly better than CXL only, in terms of lines gained. Uncorrected vision in the CXL+INTACS group improved by 1.7 lines more than in the CXL only group (p = 0.024). While the CXL+INTACS group, on average, gained 0.08 lines more than the CXL only group at 12 months postoperatively, this difference was not statistically significant (p = 0.1). The maximum keratometric value was significantly reduced by both CXL only and CXL+INTACS; however, there was, on average, a 2.45D greater flattening of KMAX in the CXL+INTACS group when compared with the CXL only group (p = 0.00003). Conclusion: Both groups (CXL only and CXL+INTACS) demonstrated significant improvements in UCVA, BSCVA, and keratometry. However, there were statistically significant greater improvements in UCVA lines gained, keratometry, and spherical equivalent in the CXL+INTACS group compared with the CXL only group.

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  1. Krachmer JH, Feder RS, Belin MW. Keratoconus and related noninflammatory corneal thinning disorders. Surv Ophthalmol 1984;28:293–322. DOI: 10.1016/0039-6257(84)90094-8.
  2. Rabinowitz YS. Keratoconus. Surv Ophthalmol 1998;42(4):297–319. DOI: 10.1016/s0039-6257(97)00119-7.
  3. Javadi MA, Motlagh BF, Jafarinasab MR, et al. Outcomes of penetrating keratoplasty in keratoconus. Cornea 2005;24(8):941–946. DOI: 10.1097/01.ico.0000159730.45177.cd.
  4. Schirmbeck T, Paula JS, Martin LFT, et al. Efficacy and low cost in keratoconus treatment with rigid gas-permeable contact lens. Arquivos Brasileiros De Oftalmologia (in Portuguese) 2005;68(2): 219–222. DOI: 10.1590/s0004-27492005000200012.
  5. Alio JL, Vega-Estrada A, Esperanza S, et al. Intrastromal corneal ring segments: How successful is the surgical treatment of keratoconus? Middle East Afr J Ophthalmol 2014;21(1):3–9. DOI: 10.4103/0974-9233.124076.
  6. Wollensak G, Spoerl E, Seiler T. Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. Am J Ophthalmol 2003;135(5):620–627. DOI: 10.1016/s0002-9394(02)02220-1.
  7. Kymes SM, Walline JJ, Zadnik K, et al. Quality of life in keratoconus. Am J Ophthalmol 2004;138(4):527–535. DOI: 10.1016/j.ajo.2004.04.031.
  8. Barr JT, Wilson BS, Gordon MO, et al. Estimation of the incidence and factors predictive of corneal scarring in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) study. Cornea 2006;25:16–25. DOI: 10.1097/01.ico.0000164831.87593.08.
  9. Davis LJ, Schechtman KB, Wilson BS, et al. Longitudinal changes in visual acuity in keratoconus; CLEK study. Invest Ophthalmol Vis Sci 2006;47:489–500. DOI: 10.1167/iovs05-0381.
  10. Labiris G, Giarmoukakis A, Sideroudi H, et al. Impact of keratoconus, cross-linking and cross-linking combined with photorefractive keratectomy on self-reported quality of life. Cornea 2012;31(7):734–739. DOI: 10.1097/ICO.0b013e31823cbe85.
  11. Asri D, Touboul D, Fournié P, et al. Corneal collagen crosslinking in progressive keratoconus: Multicenter results from the French National Reference Center for Keratoconus. J Cataract Refract Surg 2011;37(12):2137–2143. DOI: 10.1016/j.jcrs.2011.08.026.
  12. Torquetti L, Ferrara G, Almeida F, et al. Intrastromal corneal ring segments implantation in patients with keratoconus: 10-year follow-up. J Refract Surg 2014;30(1):2–26. DOI: 10.3928/1081597X-20131217-02.
  13. Coskunseven E, Jankov MR 2nd, Hafezi F, et al. Effect of treatment sequence in combined intrastromal corneal rings and corneal collagen crosslinking for keratoconus. J Cataract Refract Surg 2009;35(12):2084–2091. DOI: 10.1016/j.jcrs.2009.07.008.
  14. Rabinowitz YS, Li X, Ignacio TS, et al. INTACS inserts using the femtosecond laser compared to the mechanical spreader in the treatment of keratoconus. J Refract Surg 2006;22(8):764–771. DOI: 10.3928/1081-597X-20061001-06.
  15. Koller T, Mrochen M, Seiler T. Complication and failure rates after corneal crosslinking. J Cataract Refract Surg 2009;35(8):1358–1362. DOI: 10.1016/j.jcrs.2009.03.035.
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