Authors
Kornilovskiy I.M.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Purpose. To consider new technological approaches to ultra-fast topographically oriented preventive cross-linking with excimer laser radiation in refractive corneal surgery.
Materials and methods. The work is based on clinical observations of the immediate and long-term results of ultra-fast topographically oriented corneal cross-linking using argon-fluorine excimer laser radiation (over 500 operations) over a period of 1 month to 12 years. During photorefractive operations, the effect was carried out using a personalized ablation program according to keratotopographic studies. In a number of cases, exposure to radiation below the ablation threshold was additionally used to form a Bowman-like membrane structure on the ablation surface. A rapid transition without additional calibrations to energy densities below the ablation threshold was carried out using a Microscan Visum-500 excimer laser.
Results: The method of ultra-fast topographically oriented preventive cross-linking of the cornea was based on the activation of riboflavin by secondary radiation from an argon-fluorine excimer laser induced during photorefractive ablation. Personalized epithelial ablation was performed taking into account OCT and Scheimpflug scanning data of the cornea. The cornea was saturated with a 0.25% isotonic riboflavin solution, cooled to +5–7 ºС. The saturation time ranged from 1 to 5 minutes depending on the initial epithelial thickness and the expected volume of photorefractive stromal ablation. Clinical observations have shown that with this ablation technology in cases of TransPRK, there is a lesser postoperative aseptic inflammatory reaction, less pronounced pain syndrome, accelerated epithelization, earlier stabilized optical-refractive indices and no irreversible form of subepithelial or intrastromal fibroplasia. During LASIK and FemtoLASIK with riboflavin, in some cases, a reversible fine line of demarcation and an increase in optical density in the layers of thinned stroma were noted.
Conclusion: The use of argon-fluorine excimer laser radiation in ablative and subablative modes ensures the implementation of ultra-fast topographically oriented preventive cross-linking in refractive corneal surgery.
Keywords: cornea, riboflavin, crosslinking, excimer laser, refractive surgery.
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