Health Problem: Laser in situ keratomileusis (LASIK) is a refractive surgery procedure that reshapes the surface of the cornea with an excimer laser to focus visual images directly onto the retina and improve visual acuity. LASIK may disrupt the cornea. Post-LASIK corneal ectasia (also called keratectasia or keratoectasia) is a serious side effect that involves keratoconus-like progressive thinning and steepening of the central and inferior portions of the cornea.

Technology Description: Corneal cross-linking (CXL) uses a combination of riboflavin (vitamin B2) eye drops with ultraviolet A (UVA) radiation to trigger a photochemical reaction that changes the cross-links between and within collagen fibers in the corneal stroma. This is believed to strengthen and increase the biomechanical stiffness of the corneal stroma, thereby flattening the steepened cornea into a more normal shape so that vision improves.

Controversy: CXL may provide a treatment option for patients with post-LASIK corneal ectasia, but the procedure may carry risks for complications. In addition, it is still unclear as to whether CXL actually yields improvements in measures of visual acuity, corneal topography and thickness, refractive parameters, and quality of life. Furthermore, additional, better-quality, controlled studies are required to define the patient population that is most likely to respond to CXL.

Key Questions:

  • Does conventional CXL (C-CXL) treatment improve measures of corneal topography, visual acuity, and refraction in patients with post-LASIK corneal ectasia?
  • Is C-CXL safe in patients with post-LASIK corneal ectasia?
  • Have definitive patient selection criteria been established for C-CXL for the treatment of post-LASIK corneal ectasia?

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