Excimer laser treatment combined with riboflavin ultraviolet-A (UVA) collagen crosslinking (CXL) in keratoconus: a literature review

TY - JOUR

T1 - Excimer laser treatment combined with riboflavin ultraviolet-A (UVA) collagen crosslinking (CXL) in keratoconus: a literature review

AU - Ezzeldin, M

AU - Filev, F

AU - Steinberg, J

AU - Frings, A

PY - 2020/9

Y1 - 2020/9

N2 - 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 (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 cornea. However, long-term results are needed, as the studies in our review have a follow-up period of 68 months or less.

AB - 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 (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 cornea. However, long-term results are needed, as the studies in our review have a follow-up period of 68 months or less.

KW - Collagen/therapeutic use

KW - Corneal Stroma

KW - Corneal Topography

KW - Cross-Linking Reagents/therapeutic use

KW - Humans

KW - Keratoconus/drug therapy

KW - Lasers, Excimer/therapeutic use

KW - Photochemotherapy

KW - Photorefractive Keratectomy

KW - Photosensitizing Agents/therapeutic use

KW - Riboflavin/therapeutic use

KW - Ultraviolet Rays

U2 - 10.1007/s10792-020-01394-5

DO - 10.1007/s10792-020-01394-5

M3 - SCORING: Review article

C2 - 32361861

VL - 40

SP - 2403

EP - 2412

JO - INT OPHTHALMOL

JF - INT OPHTHALMOL

SN - 0165-5701

IS - 9

ER -