Evaluation of Topography-guided LASIK and Simultaneous Collagen Cross-linking in the Management of Post-LASIK Ectasia Diana Ng, MD1 Anastasios John Kanellopoulos,

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Evaluation of Topography-guided LASIK and Simultaneous Collagen Cross-linking in the Management of Post-LASIK Ectasia Diana Ng, MD1 Anastasios John Kanellopoulos, MD1,2 1New York University/Manhattan Eye Ear & Throat Hospital, New York 2LaserVision.gr Institute, Athens, Greece No Financial Disclosure

Purpose: Evaluation of safety and efficacy of under-the-flap, partial, topography-guided LASIK(tLASIK) combined with simultaneous in-the-flap collagen cross-linking(CXL) in the management of post-LASIK ectasia

Methods: 7 eyes of 4 patients with post-LASIK ectasia evaluated before and after tLASIK and CXL: UCVA BSCVA Refraction Keratometry(K) Topography Cornea haze(0=clear cornea, 1=mild haze, 2=moderate haze, 3=severe haze, 4=reticular haze) Ectasia Stability

Methods: All eyes had a partial topography guided ablation within the original flap Followed by single instillation of 0.1% riboflavin solution within the flap Then followed by CXL with 7mW/cm2 UVA irradiation for 10 minutes over the re-positioned flap Mean follow-up was 15.5 months (12 to 38)

Results: Visual function recovery took an average of 2 days post-operatively UCVA: from 0.21 to 0.42 BSCVA: from 0.41 to 0.57 Spherical equivalent improved: 2.1D Mean haze score: 0.4 Mean keratometry reduction: 2.4D Two eyes appeared to regress within one year

Post-LASIK ectasia: -1 -1. 75@ 75 Post-LASIK ectasia: -1 -1.75@ 75. Pach 445, Treated with topo-guided enhancement of: -1 -1.25@ 75 and 10 minutes CXL. Pre and 2 months post images seen here. Improvement of UCVA 20/60 to 20/25

Same case seen 1 year later with some ectasia regression. UCVA 20/30 Same case seen 1 year later with some ectasia regression. UCVA 20/30. BSCVA 20/20 with -0.5 -0.75@78

Conclusions: Simultaneous tLASIK and CXL carries unique advantage of rapid rehabilitation and minimal patient discomfort post-operatively It appears to be safe and potentially effective in stabilizing ectasia progression and enhancing visual rehabilitation in post-LASIK ectasia although the percentage of regression in this small group remains a disadvantage