Excimer Laser Crosslinking with Refractive Non-Ablative Modeling for Corneal Ectasia

    Original article

    Excimer Laser Crosslinking with Refractive Non-Ablative Modeling for Corneal Ectasia

    I.M. Kornilovsky

    N.I. Pirogov National Medical and Surgical Center of the Ministr y of Health of the Russian Federation, Moscow, Russian Federation

    Abstract

    Purpose. To develop a technology for excimer laser crosslinking with refractive non-ablative modeling of the cornea and to substantiate the advantages of its use in keratectasia.

    Material and methods. This study was based on experimental ex vivo (20 pig eyes) and in vivo (90 rabbit eyes) studies examining the possibility of riboflavin activation by induced secondary radiation from an argon-fluoride excimer laser. Clinical studies included a 12-year follow-up of the short- and long-term Results.of excimer laser prophylactic crosslinking in photorefractive surgery and therapeutic excimer laser crosslinking without stromal ablation for keratoectasias and corneal diseases of various etiologies (more than 800 operations). The Russian excimer laser «Microscan-Visum» from «Optosystems» was used to achieve pulse energy densities below the ablation threshold without additional calibration.

    Results. Laser-induced crosslinking effect was detected in riboflavin-rich corneal stroma after exposure to argon-fluoride excimer laser radiation in ablative and subablative modes. This allowed us to propose for the first time excimer laser prophylactic crosslinking in photorefractive surgery and therapeutic crosslinking for various corneal pathologies. Excimer laser crosslinking for keratoconus and secondary keratectasia was accompanied by a refractive modeling effect of varying degrees. This improved uncorrected and corrected visual acuity. The greatest increase in visual acuity and non-ablative refractive keratomodeling effect were achieved with the use of a gradient refractive irradiation profile according to the personalized PRK programs. The latter made it possible to outline new approaches to non-ablative refractive modeling of the cornea in induced ametropia after inflammatory, dystrophic pathology of the cornea and in the correction of weak degrees of ametropias.

    Conclusion. Laser-induced corneal crosslinking with argon-fluoride excimer laser radiation using ablative and subablative modes expands the arsenal of effective methods for treating keratoectasias, improves visual and optical-refractive Results.with a personalized effect of refractive modeling of the cornea, and allows for the development of new approaches to non-ablative correction of ametropias.

    Keywords: excimer laser, refractive keratomodeling, cornea, riboflavin, crosslinking, keratoconus, keratoectasia

    For citation: Kornilovsky I.M. Excimer Laser Crosslinking with Refractive Non-Ablative Modeling for Corneal Ectasia.Point of view. East–West. 2025;12(4): 33–41.

    DOI.https://doi.org/10.25276/2410-1257-2025-4-33-41

    Corresponding author: Igor M. Kornilovskiy, Kornilovsky51@yandex.ru