Article
Excimer Laser Treatment combined with Riboflavin Ultraviolet-A Collagen Crosslinking in Keratoconus: A Literature Review
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Published: | May 14, 2019 |
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Purpose: To review the clinical outcome of keratoconus patients after Excimer Laser treatment with combined riboflavin UV-A collagen-crosslinking (CXL).
Methods: Following a literature review of studies published in PubMed between 2012 and 2018, peer-reviewed English-written studies were evaluated using the GRADE approach (http://www.gradeworkinggroup.org/). This review focused on changes of the (un)corrected distance visual acuity (UDVA; CDVA), higher order aberrations (HOA) and prevalence of postoperative complications.
Results: Nine studies with a total of 740 eyes were included thereby reporting on 464 eyes with a combined therapy. We found evidence that differences between pre- and postoperative CDVA and UDVA were statistically significant in eight of nine studies after at least 4 months follow-up when CXL was combined with an Excimer Laser treatment compared to CXL alone. Four studies described a statistically significant reduction in HOA, especially coma and spherical aberration. In four studies corneal haze and opacity were reported but successfully treated.
Conclusion: Current studies suggest that CDVA, UDVA and HOA in low to moderate keratoconus patients benefit from a combined treatment without sacrificing biomechanical stability of the cornea. However, long term results are missing as current studies offer follow-up of 56 months or less.