LASIKXTRA:WHATDOESTHELITERATURESHOW?

LasikXtra:Restoringcornealstrength

CreationoftheLASIKflapweakensthecorneabyasmuchas30%.LasikXtratreatmentprotocolsaredesignedtoapplysufficientstiffeningtorestorethecornea

toitspre-LASIKlevelofstiffness,withoutexcessivechange

LasikXtra:CornealstrengtheningduringLASIK

ThegoalofLasikXtraistorestorebiomechanicalintegritytocorneasthathavebeenweakenedbyrefractivesurgerytoachievestable,predictablevisualoutcomesinorderto:

•  Reducetheriskofpost-LASIKrefractiveregression•  Reducetheriskofpost-LASIKectasia

Riboflavinisrinsedfromtheeye,andtheflapisrepositionedasusual

TheLASIKflapisleftopenfollowingexcimerlaserablation

Dextranfreeriboflavinisappliedtothestromalbedimmediatelyafterablation

UVAilluminationisappliedthroughtheclosedflapfor90secondsat30mW/cm2

LasikXtra:CornealstrengtheningduringLASIK

LasikXtra:MaintainingPredictability

Centertoedgebeamuniformityinsuresconsistentresults

Pan-cornealtreatment•  KXLsystemwithhomogenousbeamprofileand

largedepthoffocusisusedtocross-linktheentirecentral9mmofthecornea

•  Uniformtreatmentacrossthelargetreatmentzonerestoresstabilitywithoutredistributingcornealstresses(noshapechange)

•  Thisdiffersfromtreatmentofkeratoconus,wherethecorneahasafocalregionofweakness

LASIK+CORNEALCROSS-LINKING:KEYPOINTS

   Whatdoweknow:   LASIKweakensthecornea   Cross-linkingsCffensthecornea

   WhatDoWeNeedtoKnow?   Canwesafelyaddcross-linkingtoLASIK?   CanweachievepredictablerefracCveoutcomeswithLasik

Xtra?   CanLasikXtraimprovecornealstability?

LasikXtra:ClinicalResults

LasikXtra:SafetyPublishedstudiesshownoendothelialcellloss

•  CelikHU,AlagözN,YildirimY,etal.Acceleratedcornealcrosslinkingconcurrentwithlaserinsitukeratomileusis.JCataractRefractSurg.2012;38(8):1424–31

•  KanellopoulosAJ.Long-termsafetyandefficacyfollow-upofprophylactichigherfluencecollagen

cross-linkinginhighmyopiclaser-assistedinsitukeratomileusis.ClinOphthalmol.2012;6:1125–30.•  TomitaM,YoshidaY,YamamotoY,MitaM,WaringG.Invivoconfocallasermicroscopyof

morphologicchangesaftersimultaneousLASIKandacceleratedcollagencrosslinkingformyopia:One-yearresults.JCataractRefractSurg.2014;40(6):981–90.

•  MazzottaC,BalestrazziA,TraversiC,CaragiuliS,CaporossiA.InvivoConfocalMicroscopyReport

afterLasikwithSequentialAcceleratedCornealCollagenCross-LinkingTreatment.CaseRepOphthalmol.2014;5(1):125–31.

•  WuY,TianL,WangL,HuangY.EfficacyandSafetyofLASIKcombinedwithAcceleratedCorneal

CollagenCross-LinkingforMyopia:SixMonthStudy.BiomedResInt.2016;5083069.

LasikXtra:Safety

•  Inastudyapplying9mW/cm2CXL,agreaterpost-operativeinflammatoryresponsewasseenintheLasik+CXLgroupduringthefirstpostoperativeweek.

•  DLKresolvedinalleyesby1week.•  NoeyesineithergrouplostCDVAat1year

post-operatively.

SuperficialcornealcrosslinkingduringlaserinsitukeratomileusisTheoG.Seiler,MD,IsaakFischinger,MD,TobiasKoller,MD,ViktorDerhartunian,MD,TheoSeiler,MD,PhDJCataractRefractSurg2015;41:2165–2170

AdjunctiveCollagenCrosslinkingoftheResidualStromalBedinLASIK:FiniteElementAnalysisofImpactonRefractiveOutcomeandSurgicallyInducedDeformation

LASIK

IOP15MMHG IOP30MMHG

PRE-OP

LASIK+Cross-linking

SevenI,RoyASR,DuppsBJ,ClevelandClinicColeEyeInstitute.ARVO;2014

LASIK15MM(microns)

LASIK+CXL15MM(microns)

LASIK30MM(microns)

LASIK+CXL30MM(microns)

1 194 183 393 371

2 206 195 419 396

3 205 194 416 394

4 270 254 547 516

P<0.05 P<0.05

RESULT:LASIKwithCXLoftheRSBemployinga50%increaseinanteriorRSBstiffnesscontributedlessthan0.25DofhyperopiceffecttothepostoperativerefractiveerrorandsignificantlyreducedcornealdisplacementsafterLASIK.

SIMULATION:-4.25DLASIKprocedure,wavefrontoptimizedablationprofilewithOZD6.5mm.CXLofthecentral9mmoftheRSBwithdepth200micronandstiffeningfactor1.5.Tangentialcurvaturesofanteriorsurfacepointswerecalculated

LasikXtra:Predictability

InvivoconfocallasermicroscopyofmorphologicchangesaftersimultaneousLASIKandacceleratedcollagencrosslinkingformyopia:One-yearresults

MinoruTomita,YukoYoshida,YusukeYamamoto,MarikoMita,GeorgeWaringIV,JCRSVol40,JUNE2014

LasikXtra:Predictability

SphericalEquivalentRefractiveAccuracyLASIKvs.LASIKXtraat3Months

JerryTan,MDEurJofOphthalmology2015

LasikXtra:Predictability

LasikXtra:PredictabilityShort-termVarianceofRefractiveOutcomesAfterSimultaneousLASIKandHigh-FluenceCross-linkinginHighMyopicCorrectionTommyC.Y.Chan,FRCS;MarcoC.Y.Yu,PhD;et.al.JRefractSurg.2016;32(10):664-670WhilethepreviousstudiesofLasikXtraconductedwith30mW/cm2irradiance(KXL)showequivalentorbetterpredictabilitythanLASIKalone,thisstudyconductedusing18mW/cm2irradiance(CXL-Vario)demonstratedbetterpredictabilityintheLASIK-onlygroupthanintheLasik+CXLgroup.

InvivoconfocallasermicroscopyofmorphologicchangesaftersimultaneousLASIKandacceleratedcollagencrosslinkingformyopia:One-yearresultsMinoruTomita,MD,PhD,YukoYoshida,BA,YusukeYamamoto,MD,MarikoMita,MD,PhD,GeorgeWaringIV,MD.JCATARACTREFRACTSURG-VOL40,JUNE2014

LasikXtra:Stability

Comparisonofprophylactichigherfluencecornealcross-linkingtocontrol,inmyopicLASIK,oneyearresults.KanellopoulosAJ,AsimellisG,KarabatsasC.ClinOphthalmol.2014Nov27;8:2373-81

LasikXtra:Stability

Topography-guidedHyperopicLASIKWithandWithoutHighIrradianceCollagenCross-linking:InitialComparativeClinicalFindingsinaContralateralEyeStudyof34ConsecutivePatients.KanellopoulosAJ,AsimellisGJournalofRefractiveSurgery2012

AdjuvantcornealcrosslinkingtopreventhyperopicLASIKregression.AslanidesIM,MukherjeeAN.Clin.Ophthalmol.2013

LasikXtra:Stability

•  Hyper-reflectivityandkeratocyteapoptosistoastromaldepthof150-160µm

•  Keratocyterepopulationcompleteby6monthspostoperatively

•  Noendothelialdamagewasobserved

•  Findingssuggestmicrostructuralchangessimilartothosefoundwithconventionalcross-linking

MazzottaC,BalestrazziaA,TraversiaC,CaragiuliaS,CaporossibACaseRepOphthalmol2014;5:125–

131

ConfocalMicroscopy

LasikXtra:ReviewAr0cles

LASIK+CORNEALCROSS-LINKING:LASIKXTRAKEYPOINTS

   Whatdoweknow:   LASIKweakensthecornea   Cross-linkingsCffensthecornea

   WhatDoWeNeedtoKnow?   Canwesafelyaddcross-linkingtoLASIK?   CanweachievepredictablerefracCveoutcomes

withLasikXtra?   CanLasikXtraimprovecornealstability?

THANKYOU