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Very high-frequency collagen cross-linking enhances astigmatic keratotomy
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WAIKOLOA, Hawaii — A novel combination of accelerated cross-linking and femtosecond astigmatic keratotomy may significantly enhance the efficacy of the astigmatic keratotomy in a variety of scenarios, a speaker said here.
Reporting on behalf of A. John Kanellopoulos, MD, at Hawaiian Eye 2013, presenter Vance M. Thompson, MD, FACS, illustrated the positive effects of the procedure in four situations: after PK, after cataract surgery, as regression enhancement, and in clear cornea incisions. In all cases, accelerated corneal cross-linking enhanced the effect of astigmatic keratotomy, Thompson said.
Vance M. Thompson
Reporting Kanellopoulos’ series of 15 eyes of 13 consecutive post-cataract patients with standard 6-month follow-up, Thompson, an OSN Refractive Surgery Board Member, said two 30° arcuate optical coherence tomography-guided femtosecond astigmatic keratotomy incisions were performed with the LenSx laser (Alcon) at the 7-mm optical zone at 85% depth. Kanellopoulos, an OSN Europe Edition Board Member, manually opened the incisions with a Sinskey hook, put in one drop of 0.1% riboflavin sodium phosphate in one of the incisions for 1 minute, and then performed the very high-frequency collagen cross-linking.
“Of note, this was done in only one incision,” Thompson said. “What [Kanellopoulos] found was that, in the incisions, the meridional astigmatic change in those that just had the astigmatic keratotomy had less effect than in those that had the astigmatic keratotomy plus the high-frequency collagen cross-linking, which nearly doubled the effect of the astigmatic keratotomy.”
The difference between the meridional astigmatic change in the cross-linking and non-cross-linking incisions was statistically significant.
“This novel combination of accelerated cross-linking may significantly enhance femtosecond astigmatic keratotomy efficacy following astigmatic keratotomy in multiple situations,” Thompson said. “The beauty of it is, is that it is potentially titratable on the basis of energy delivery alone.”
Disclosure: Thompson does research for and is on the medical advisory board for Avedro. Kanellopoulos is a consultant for Alcon, WaveLight and Avedro.