Risk of delayed healing makes strict inclusion criteria advisable for combined cross-linking, PRK
ROME — The combination of cross-linking and photoablation for refractive purposes poses many unanswered questions, and a cautious attitude is advisable, according to one surgeon.
“For the time being, I think we should keep to a strict protocol that limits the amount of tissue to be removed and takes into account that healing problems may arise,” Vikentia Katsanevaki, MD, said at the joint Refractive.online and SICCSO meeting.
In some of Katsanevaki’s patients, delayed healing occurred after cross-linking and PRK — “an experience I never had in more than 15 years with PRK alone,” she said.
The same complication was seen in some eyes after cross-linking alone, which made Katsanevaki wonder whether the trigger of this event may be cross-linking or the combination of cross-linking and photoablation.
“The problem is that we don’t have any predictive factors or enough clinical data to determine who are the patients at risk for delayed healing and, consequently, poor visual outcome,” she said.
She personally adopted strict criteria for combined PRK and cross-linking: corneas with at least 450 µm thickness, no more than 50 µm to 60 µm of photoablation, and 20/50 or better preoperative vision.
“If the disease is too advanced and spectacle vision is poor, patients cannot expect to have much of an improvement by a refractive procedure,” Katsanevaki said.
In her busy practice, where both cross-linking and PRK are performed routinely in a high number of patients, there have been only 70 patients so far who she considered eligible for the combined procedure.