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   Table of Contents      
Year : 2018  |  Volume : 66  |  Issue : 7  |  Page : 993-994

Clinical presentation following photorefractive intrastromal cross-linking for myopic correction

Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India

Date of Submission07-Jan-2018
Date of Acceptance14-Mar-2018
Date of Web Publication25-Jun-2018

Correspondence Address:
Gitansha Shreyas Sachdev
The Eye Foundation, 582-A, DB Road, RS Puram, Coimbatore - 641 002, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1227_17

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Keywords: Collagen cross-linking, myopia, photorefractive intrastromal cross-linking

How to cite this article:
Sachdev GS, Ramamurthy S. Clinical presentation following photorefractive intrastromal cross-linking for myopic correction. Indian J Ophthalmol 2018;66:993-4

How to cite this URL:
Sachdev GS, Ramamurthy S. Clinical presentation following photorefractive intrastromal cross-linking for myopic correction. Indian J Ophthalmol [serial online] 2018 [cited 2020 Dec 4];66:993-4. Available from: https://www.ijo.in/text.asp?2018/66/7/993/234959

  Case Report Top

A 23-year old female presented to our Refractive Services seeking independence from spectacles. Her unaided distance visual acuity (UDVA) was 6/18 and 6/6 in the right and left eye, respectively. The best-corrected distance visual acuity in the right eye was 6/6 with a stable refractive correction of − 1.25 Diopter (D) sphere for the past 3 years. Anterior segment and fundus evaluation were within normal limits. Corneal topography was within normal limits with a mean keratometry (Km) of 46.2D and a thinnest pachymetry of 530 um [Figure 1]. Photorefractive intrastromal cross-linking (PiXL) for the right eye was performed. A written informed consent was obtained before the procedure. High fluence ultraviolet-A irradiation of 15 J/cm 2 was delivered over the central 4 mm, using the Mosaic device (Avedro, Waltham, MA). Oxygen was supplemented externally to increase the efficacy of the transepithelial approach. At 1-month postoperative visit, her UDVA in the right eye was 6/6. Slit lamp evaluation revealed a central 4 mm disc of haze with a corresponding demarcation line on anterior segment optical coherence tomography [Figure 2] and [Figure 3]. Corneal topography at 3 months demonstrates a flattening in the central 4 mm zone with a Km of 44.4D [Figure 4]. No regression or endothelial cell loss was noted over the 6-month follow-up period. On administrating the questionnaire, the patient reported freedom from glasses for 100% of her activities with a satisfaction score of 5/5.
Figure 1: Preoperative corneal tomography with a mean keratometry of 46.2D

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Figure 2: Slit lamp evaluation at 1-month postoperative visit reveals a central disc of haze

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Figure 3: Anterior segment optical coherence tomography demonstrating a well-defined demarcation line in the central 4 mm zone

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Figure 4: Corneal tomography at 3 months demonstrates a central corneal flattening of 1.8D

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  Discussion Top

Kanellopoulos described the preliminary results of PiXL and noted an average corneal flattening of 1.4 D at 1 month.[1] Lim et al. demonstrated the results in a cohort of 14 eyes with a mean reduction in spherical equivalent of 0.72 ± 0.43D using the epithelium on approach.[2] Elling et al. demonstrated superior visual outcomes in 26 eyes undergoing PiXL following epithelial debridement.[3]

  Conclusion Top

This photo essay demonstrates the clinical changes which ensue following PiXL, which were not demonstrated in the published data.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Kanellopoulos AJ. Novel myopic refractive correction with transepithelial very high-fluence collagen cross-linking applied in a customized pattern: Early clinical results of a feasibility study. Clin Ophthalmol 2014;8:697-702.  Back to cited text no. 1
Lim WK, Soh ZD, Choi HK, Theng JT. Epithelium-on photorefractive intrastromal cross-linking (PiXL) for reduction of low myopia. Clin Ophthalmol 2017;11:1205-11.  Back to cited text no. 2
Elling M, Kersten-Gomez I, Dick HB. Photorefractive intrastromal corneal crosslinking for the treatment of myopic refractive errors: Six-month interim findings. J Cataract Refract Surg 2017;43:789-95.  Back to cited text no. 3


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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