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Epithelial Remodeling After Femtosecond Laser-assisted High Myopic LASIK: Comparison of Stand-alone With LASIK Combined With Prophylactic High-fluence Cross-linking

Kanellopoulos, Anastasios J. MD*,†; Asimellis, George PhD*

doi: 10.1097/ICO.0000000000000087
Clinical Science

Purpose: The aim of this study was to evaluate the possible topographic epithelial profile thickness changes (remodeling) after high myopic femtosecond laser in situ keratomileusis (LASIK) with concurrent prophylactic high-fluence cross-linking (CXL) in comparison with standard femtosecond LASIK.

Methods: Preoperative and 6-month postoperative 3-dimensional epithelial thickness distribution maps were investigated through clinical spectral domain anterior-segment optical coherence tomography in 2 groups of femtosecond laser–assisted myopic LASIK cases. Group A represented 67 eyes treated additionally with concurrent prophylactic CXL (LASIK-Xtra); group B represented 72 eyes subjected to stand-alone femtosecond LASIK. Optical coherence tomography measurements of the epithelial thickness over the center 2-mm-diameter disk, mid-peripheral 5-mm rim, and overall (the entire 6-mm-diameter disc area) were investigated.

Results: The comparison of matched myopic correction subgroups indicated statistically significant differences in the epithelial thickness increase specifically between high myopia subgroups. For example, in group A (LASIK-Xtra), the mid-peripheral epithelial thickness increase was +3.79 and +3.95 μm for the “−8.00 to −9.00 diopter” and “−7.00 to −8.00 diopter” subgroups, which compare with increased thickness in group B (stand-alone LASIK), of +9.75 μm (P = 0.032) and +7.14 μm (P = 0.041), respectively, for the same subgroups.

Conclusions: Application of prophylactic CXL concurrently with high myopic LASIK operation results in a statistically significant reduced epithelial increase in comparison with stand-alone LASIK. This comparison is observed between matched high myopic correction subgroups. This difference may correlate with higher regression rates and/or may depict increased biomechanical instability in stand-alone LASIK.

* Eye Institute, Athens, Greece; and

Department of Ophthalmology, Langone Medical Center, NYU Medical School, New York, NY.

Reprints: A. John Kanellopoulos, MD, Medical Director, the Eye Institute, 17 Tsocha Street, Athens, Greece 115 21 (e-mail:

A. J. Kanellopoulos is a consultant and holds advisory positions with Alcon/WaveLight, Allegran, Avedro, and i-Optics. G. Asimellis has no funding or conflicts of interest to disclose.

Design and conduct of the study (A.J.K.); collection (A.J.K. and G.A.), management (A.J.K.), analysis (G.A.), and interpretation of the data (A.J.K. and G.A.); manuscript preparation (G.A.), review (A.J.K. and G.A.), and approval (A.J.K.).

Received August 07, 2013

Accepted January 09, 2014

© 2014 by Lippincott Williams & Wilkins.