Crosslinking for post-laser-assisted in situ keratomileusis corneal ectasia: Transepithelial flap-on 30 minute and flap-lift 4 minute protocol

PURPOSE: To evaluate the outcomes of transepithelial corneal collagen crosslinking (CXL) for management of corneal ectasia after laser-assisted in situ keratomileusis (LASIK). METHODS: CXL was performed on 18 eyes of 16 patients either with LASIK flap lift (n = 9; 365 nm, 30 mW/cm(2), 4 minutes, pulse) or with transepithelial flap-on (n = 9 eyes; 365 nm, 3 mW/cm(2), 30 minutes) technique. Postoperative change in maximum keratometry (Kmax), anterior elevation, posterior elevation, spherical equivalent (SE), logMAR uncorrected distance visual acuity (UDVA), aberrations, and central corneal thickness (CCT) were evaluated at 12 months postoperatively. RESULTS: A total of 18 eyes of 16 patients (11 males, 5 females) were included. Overall, Kmax flattened more after flap-on CXL (P = 0.014) compared to flap-lift CXL. The endothelial cell density and posterior elevation were stable throughout the follow-up period. Index of vertical asymmetry (IVA), keratoconus index (KI), and central keratoconus index (CKI) decreased after flap-on CXL at 12 months, postoperatively (P < 0.05), whereas there were no statistically significant changes in these parameters after flap-off CXL group. The spherical aberrations and total root mean square decreased after flap-lift CXL at 12 months, postoperatively (P < 0.05). CONCLUSION: In our study, transepithelial collagen crosslinking was successfully used to halt disease progression in post-LASIK keratectasia. We recommend flap-on surgical technique for these cases.