EyeWorld Asia-Pacific December 2016 Issue

December 2016 46 EWAP refractive Predictable - from page 44 continued on page 49 between the groups with and without controlled procedures in terms of stability of results,” Dr. Pinelli said, explaining that he has used PiXL for about 3 months in about 100 cases. A. John Kanellopoulos, MD , medical director, Laser- Vision.gr Eye Institute, Athens, who pioneered research with numerous crosslinking techniques, said PiXL has shown some “remarkable excimer-like effects … without tissue removal, making it a promising treatment for progressive keratoconus, corneal ectasia, and even refractive correction in low myopes, but it has a long way to go.” “PiXL offers a new indication of not only stabilizing the cornea with crosslinking but also being able to, through the predetermined variable pattern and variable fluence, result in a predictable refractive effect,” Dr. Kanellopoulos said. Dr. Kanellopoulos said eventually he thinks this individualized, topography-based crosslinking technique will replace conventional corneal collagen crosslinking as the keratoconus treatment of choice. “If one has in his armamentarium the availability of PiXL, it automatically becomes the treatment of choice because not only can it stabilize ectasia through its efficacy and safety and introduction of higher corneal rigidity, but it can also through its variable pattern help improve the refractive effect,” he said, noting that correction of irregular myopic astigmatism, which is especially linked to keratoconus and post-LASIK ectasia, would be an extreme benefit to patients. PiXL compared to crosslinking combo procedures PiXL is not the only procedure that seeks to address refractive error while ensuring a stable cornea. Conventional crosslinking has also been combined with topography- guided PRK, intrastromal rings, and LASIK. Dr. Kanellopoulos said that while traditional crosslinking in and of itself can result in a 1.5– 2 D correction of irregular astigmatism and flattening, when performed after PRK—the Athens protocol physicians can achieve up to 15 D of correction. Dr. Pinelli said that when refractive error of up to 2 D remains after transepithelial crosslinking (also known as epi-on crosslinking where the epithelium is not removed prior to soaking the cornea with riboflavin as it would be in epi-off procedures), he usually corrects it with an advanced surface ablation technique. For higher diopters of refractive error, Dr. Pinelli said he usually performs intraocular surgery, such as a lensectomy or phakic IOL implant, 3 months post-crosslinking. Dr. Behndig told EyeWorld that the fact that PiXL doesn’t remove any tissue might be an advantage, but he acknowledged that PRK may have better refractive precision. “We don’t know which factors make one treatment—PiXL or crosslinking and PRK—better than the other in the individual case,” he said. Dr. Kanellopoulos said he thinks PiXL could be combined with topography-guided PRK as well for even better refractive outcomes. Join the largest subspecialty society representing the fields of cornea and external disease. Member Benefits • Cornea : The Journal of Cornea and External Disease • Annual Meetings: Select discounted registration at membership events and educational programs • VideoEd: A weekly broadcast of clinical videos recorded live at national and international cornea meetings • K era -net: The online forum for the exchange of clinical and scientific information • Cornea Society News : Quarterly newsletter sent to all Society mem bers CorneaSociety .org Save the Date July 8-9, 2020 World Cornea Congress VIII Singapore 2020 corneacongress.org/2020