/ /

  • linkedin
  • Increase Font
  • Sharebar

    CXL-LASIK reinforces cornea stability

    Stabilization with concurrent CXL helps maintain LASIK treatment effects



    Performing collagen crosslinking as a concurrent primary LASIK procedure—show data from comparative studies of patients with hyperopia and myopia at risk for ectasia or regression postLASIK—increases postoperative refractive and keratometric stability.


    Athens, Greece—About 1 in 40 patients who present for laser vision correction of myopia to the private surgery center of A. John Kanellopoulos, MD, in Athens, Greece, have topographic evidence of keratoconus.

    Considering the endemic nature of this disease in his patient population—together with evidence demonstrating the occurrence of long-term refractive regression after LASIK for hyperopia and high myopia—in 2007 Dr. Kanellopoulos introduced performing collagen crosslinking (CXL) concurrently with primary LASIK in all patients with hyperopia and myopia considered at risk for ectasia or regression.

    He theorized that the addition of CXL would stabilize the cornea, and results from subsequent comparative studies demonstrate the combined procedure (known as LASIK-Xtra) is effective for increasing refractive and keratometric stability.

    “Although not universally considered mainstay, LASIK-Xtra requires just 2.5 minutes of additional time following routine LASIK, and may provide reinforcement to the known inadvertent biomechanical change associated with standard LASIK,” said Dr. Kanellopoulos, medical director, Laservision.gr Eye Institute, Athens, and clinical professor of ophthalmology, New York University Medical College, New York.

    Currently, Dr. Kanellopoulos performs LASIK-Xtra in patients with myopia exhibiting any of the following characteristics:

    • Spherical error ≥–6 D.
    • Age <30 years.
    • Astigmatism >1.5 D.
    • Intereye astigmatism difference ≥1 D.

    The CXL procedure is performed following the excimer laser ablation. Being careful to protect the flap and hinge from riboflavin exposure, 0.10% saline-diluted riboflavin solution is applied directly onto the stromal bed, he said.

    After a 60-second soak time, the flap is replaced and residual riboflavin removed by irrigation. Once the flap position is secured, the cornea is irradiated with the UVA light source using a fluence of 30 mW/cm2.

    Dr. Kanellopoulos is currently using an exposure time of 80 seconds.

    “In contrast to epi-on CXL, a key concept here is to have minimal riboflavin present in the epithelium and flap stroma,” Dr. Kanellopoulos said. “Therefore, the UV light can penetrate through freely and interact with the underlying stroma soaked with riboflavin.”


    Cheryl Guttman Krader
    Cheryl Guttman Krader is a contributor to Dermatology Times, Ophthalmology Times, and Urology Times.

    New Call-to-action


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available


    View Results