NEW ORLEANS — Surgeons should not perform primary corneal cross-linking in some LASIK cases and should consider PRK in high-risk cases, a speaker told colleagues here.
“The risk-benefit ratio for routine collagen cross-linking in primary LASIK does not justify the routine application because we have other options such as PRK for high-risk cases,” Perry S. Binder, MD, said during Refractive Surgery Subspecialty Day preceding the American Academy of Ophthalmology meeting.
Cross-linking is associated with long-term keratocyte and stromal cell loss, potential endothelial cell damage, increased corneal stiffening and reversal of stress distribution; a flat cornea becomes steep and a steep cornea becomes flat, Binder said.
Complications include lack of effect, corneal scarring, corneal infiltrates, delayed epithelial healing and severe postoperative pain, Binder said.
In addition, there are few peer-reviewed studies on cross-linking for primary LASIK cases, he said.
Binder recommended that surgeons refrain from performing cross-linking on LASIK cases until the risks and benefits have been determined.
Risks can be reduced by irradiating focal areas of the operated cornea and determining the depth and stiffness of treatment using confocal microscopy, optical coherence tomography and Brillouin microscopy, Binder said.
Exposure time, irradiation levels, epithelium-on or epithelium-off with or without accelerators, and other photosensitizers such as verteporfin (Visudyne, Valeant Ophthalmics) should be considered to assess risk and improve outcomes, he said.
Phakic IOLs may be considered in cases in which PRK cannot be justified, Binder said.
Disclosure: Binder has financial relationships with Abbott Medical Optics, Accelerated Vision, AcuFocus, Outcomes Analysis Software and Stroma.