Three-Year Outcomes of Cross-Linking PLUS (Combined Cross-Linking with Femtosecond Laser Intracorneal Ring Segments Implantation) for Management of Keratoconus

Purpose. To analyze the results of three-year outcomes of combined epithelium-on cross-linking with femtosecond laser ICRS (cross-linking PLUS) for keratoconus management. Design. A retrospective multicenter clinical study. Methods. 43 eyes of 38 patients were subjected to preoperative and postoperative UCVA, BCVA, refraction, Pentacam pachymetry, and keratometry examinations at 3-, 6-, 12-, 24-, and 36-month follow-up period. Results. The preoperative and postoperative mean UCVA was 1.30 ± 0.48 (logMAR ± SD) and 0.82 ± 0.22 respectively. The preoperative and postoperative mean BCVA was 0.90 ± 0.40 and 0.60 ± 0.30, respectively. The preoperative and postoperative mean K average was 50.63 ± 0.87 (D ± SD) and 45.56 ± 0.98, respectively. The preoperative and postoperative mean pachymetry was 471 ± 92.36 (μm ± SD) and 423 ± 39.58, respectively. The preoperative and postoperative mean astigmatism was 7.55 ± 1.75 and 3.39 ± 1.26, respectively. One eye showed ICRS edge exposure while 6 eyes showed progression of keratoconus. Conclusion. CXL PLUS was proved to be a successful procedure to halt progression (mainly by CXL) and to correct the refractive status of the keratoconic eye (mainly by ICRS). CXL PLUS performed a synergistic action correcting and maintaining the correction of both myopic and astigmatic components of keratoconus

A Comparative Study: The Use of Collagen Implant versus Mitomycin-C in Combined Trabeculotomy and Trabeculectomy for Treatment of Primary Congenital Glaucoma

Purpose. To compare Ologen implant versus mitomycin-C (MMC) in combined trabeculotomy and trabeculectomy as a treatment of primary congenital glaucoma. Setting. Sohag University Hospital, Egypt. Design. A prospective comparative study. Methods. Thirty-four eyes of twenty-one patients with primary congenital glaucoma were included in this study. All patients were subjected to preoperative evaluation including complete anterior segment examination under general anesthesia. The patients were divided into two groups: patients of the first group (group A) underwent combined trabeculotomy and trabeculectomy with Ologen implantation while those of the second group (group B) underwent combined trabeculotomy and trabeculectomy with MMC application. Results. Postoperatively, the IOP in group A was as follows: 8 eyes developed IOP levels less than 14 mmHg (complete success), 3 eyes had levels between 14 and 16 mmHg (accepted result), 2 eyes had levels between 16 and 20 mmHg (guarded result), and only 2 eyes showed levels exceeding 20 mmHg (failed procedure), while in group B, 7 eyes showed complete success, 3 eyes had accepted result, 3 eyes had guarded result, and 2 eyes had failed procedure. Conclusion. Ologen is a safe and effective adjuvant in combined trabeculotomy and trabeculectomy for treatment of primary congenital glaucoma