Excimer laser treatment combined with riboflavin ultraviolet-A (UVA) collagen crosslinking (CXL) in keratoconus: a liter
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REVIEW
Excimer laser treatment combined with riboflavin ultraviolet-A (UVA) collagen crosslinking (CXL) in keratoconus: a literature review M. Ezzeldin . F. Filev . J. Steinberg . A. Frings
Received: 29 January 2020 / Accepted: 18 April 2020 Ó The Author(s) 2020
Abstract Purpose To review the clinical outcome of keratoconus patients after excimer laser treatment with combined riboflavin UV-A collagen crosslinking (CXL) treatment was reviewed in light of the UDVA, CDVA and HOA. Methods Following a PubMed-based literature review of studies on excimer laser treatment with combined riboflavin UV-A CXL published between 2009 and 2018, peer-reviewed English-written studies were evaluated using the GRADE approach (www. gradeworkinggroup.org). The current review focused on the change in the (un)corrected distance visual acuity (UDVA; CDVA) and higher-order aberrations
This review was presented at the 32nd International Congress of the ‘‘Deutsche ophthalmologische Gesellschaft: DOC’’ which took place at 23.05.–25.05.2019 in Nuremberg, Germany [1]. M. Ezzeldin A. Frings (&) Department of Ophthalmology, University Hospital Duesseldorf, Moorenstraße 5, 40225 Duesseldorf, Germany e-mail: [email protected] F. Filev J. Steinberg Department of Ophthalmology, University Hospital Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany
(HOA) as well as the prevalence of postoperative complications. Results Five studies with a total of 573 eyes were included, thereby reporting on 479 eyes were treated with the aforementioned combination therapy. The control group consisted of 94 eyes in total. Changes between pre- and postoperative CDVA and/or UDVA were statistically significant in all five studies after at least a 24-month follow-up period for the combined excimer laser-assisted CXL treatment in comparison with the CXL-only treatment option. Three studies described statistically significant reduction in the number of total HOA, in particular, those related to coma and spherical aberration. Corneal haze was reported in four studies, but the condition was successfully treated in all cases. Conclusion Current studies suggest that CDVA, UDVA and HOA in low-to-moderate keratoconic patients improved in a combined treatment without sacrificing biomechanical stability of the J. Steinberg Hamburg Visionclinic (Zentrum Sehstaerke), Martinistr. 64, 20251 Hamburg, Germany A. Frings UCL Institute of Ophthalmology, 11-43 Bath St, London EC1V 9EL, UK A. Frings Augenarztpraxis Dr. Frings, Fa¨rberstraße 20, 90402 Nuremberg, Germany
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cornea. However, long-term results are needed, as the studies in our review have a follow-up period of 68 months or less. Keywords Photorefractive keratectomy Keratoconus Collagen-crosslinking Refractive surgery
Introduction One of the current treatment options for keratoconus is a combined therapy of riboflavin ultraviolet-A (UVA) collagen crosslinking (CXL) which aims to stop disease progression and requires no lengthy and te
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