Abstract
Purpose: To study the effect of LASIK with accelerated CXL on corneal endothelium in myopic diabetic patients. Methods: A prospective comparative interventional case series study on 120 eyes of 60 myopic patients treated with LASIK with accelerated CXL. They were divided into two groups; group A included 60 eyes of diabetic patients, group B included 60 eyes of non-diabetic patients. Corneal endothelium was evaluated by specular microscope preoperatively and after 3 and 6 months postoperatively. Results: The endothelial cells density (ECD) showed statistically significant changes after 3 and 6 months postoperatively (p-value <0.001) in group A while group B showed statistically significant changes after 3 months without significant change after 6 months (p-value= 0.103), both groups had improved to near preoperative levels, with no significant differences between them at the end of 6 months follow-up (p-value = 0.219). Regarding pleomorphism, there was a significant change in group A during 6 months follow-up (p-value <0.001) with no significant change in group B (p-value= 0.884), and in comparing both groups, there was a significant change at the end of 6 months follow-up (p-value <0.001). Regarding polymegathism, there was a significant change in group A during 6 months follow-up (p-value <0.001) with no significant change in group B after 3 (p-value= 0.178) and 6 (p-value= 0.866) months follow-up, and in comparing both groups, there was a significant change at the end of 6 months follow-up (p-value <0.001). Conclusion: LASIK with accelerated CXL is safe on corneal endothelium in diabetic myopic patients but needs to follow up for a long period.
Highlights
Laser-in situ keratomileusis (LASIK) is considered the most common form of refractive surgery performed nowadays and provides stable refractive and visual results but has uncommon but potentially dangerous complications such as post-LASIK ectasia
In a prospective comparative interventional case series study, 120 eyes of 60 myopic patients were treated with LASIK and accelerated CXL at the International Eye Centre and Roaa Laser Vision Correction Centre between October 2019 and March 2021 January; they were divided into 2 groups: Group A: Involved 60 eyes of 30 diabetic patients
120 eyes of 60 myopic patients were included in the study. They were divided into 2 groups; group A included 60 eyes of 30 diabetic patients (18 males and 12 female) with a mean age of 19-35 years (25.2±4.49), group B included 60 eyes of 30 nondiabetic patients (11 male and 19 female) with a mean age of 19-37 years (28.13±5.72)
Summary
Laser-in situ keratomileusis (LASIK) is considered the most common form of refractive surgery performed nowadays and provides stable refractive and visual results but has uncommon but potentially dangerous complications such as post-LASIK ectasia. Corneal collagen cross-linking (CXL) acts by increasing the chemical bonds between collagen fibers of the cornea with an increase in mechanical stiffness with stoppage of progression of keratoconus and post-LASIK ectasia [3, 4]. Simultaneous LASIK and accelerated CXL (LASIK Xtra) have recently been proposed as a way to reduce the risk of postLASIK ectasia and regression [5 - 7]. The cornea is kept all the time in a state of continuous dehydration via the active fluid pump and barrier function in the corneal endothelium. Any disturbance in these activities leads to the affection of the corneal transparency [11]. DM could reduce ECD and the percentage of hexagonal cells but increase coefficient of variation (CV), indicating that diabetes causes the corneal endothelial cell to be unstable [13]
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