Live News from the 2012 American Academy of Ophthalmology Meeting

Don’t combine routine corneal cross-linking (CXL) with primary LASIK. This was the contention of Perry S. Binder, MD, during a session at the Refractive Surgery meeting on Friday. “Do not perform corneal cross-linking on primary LASIK cases until we can determine the risk and benefits. If in doubt about a possible high-risk case, consider PRK or a phakic IOL.”

He noted that some arguments can be made for routinely performing CXL at the time of LASIK, particularly the fear of post-LASIK ectasia and the inability to detect all at-risk patients.

However, Dr. Binder said that these considerations are outweighed by the potential risks of combining these procedures. Among the potential risks are:

• Infection due to increased surgical manipulation and bed exposure time
• Possible deep stromal cell loss compared with more superficial loss seen with LASIK alone
• Variations in ultraviolet A (UV-A) and riboflavin diffusion
• Unknown effects on stability of refraction as well as on primary and enhancement excimer laser ablation rates
• UV-A exposure of other ocular tissues, such as corneal stem cells, conjunctiva and lens

He added that the incidence of post-LASIK ectasia is decreasing, and methods for detecting risk are improving, such as better topography algorithms and measurement of epithelial thickness to detect abnormal eyes early.
—Lori Roniger

Dr. Binder is a consultant to Abbott Medical Optics, AcuFocus and Stroma; receives lecture fees from Abbott Medical Optics and AcuFocus; has an equity interest in AcuFocus; and has a patents/royalties interest in Outcomes Analysis Software.